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Numerous recent studies have found that patients with multivessel coronary artery disease undergoing percutaneous coronary interventions (PCIs) experience lower mortality and/or complication rates when they are receive complete revascularization (CR).1-15 Despite this fact, the percentage of patients undergoing PCI with incomplete revascularization (IR) continues to be quite high, with some studies reporting rates in excess of 65%.2,5,14
Despite the many studies that have compared outcomes for IR vs CR among PCI patients with multivessel disease, little is known about the predictors of IR, the extent to which it occurs after a failed attempt at CR, and the variation across operators in the use of IR, particularly after adjusting for factors proven to be associated with IR.
The primary purposes of this study were (1) to examine the extent of operator practice pattern variation in the use of IR for PCI, (2) to examine the relationship between IR use for PCI and various operator (volume, years in practice) and hospital (volume, teaching status) characteristics, and (3) to determine the extent to which CR is attempted unsuccessfully. Other purposes are to identify the patient-level factors that are associated with IR and to confirm that IR with PCI is still associated with higher mortality in comparison to CR. These studies were conducted using New York State's Percutaneous Coronary Interventions Reporting System (PCIRS).
Methods
Databases
The databases used to conduct the study were the PCIRS and New York's Vital Statistics file. The PCIRS was created in 1992 for the purpose of evaluating and improving the quality of PCIs in New York through the risk adjustment of outcomes and dissemination of reports to hospitals, cardiologists, and the public. It contains demographics; patient risk factors; complications; hospital and cardiologist identifiers; admission, discharge, and procedure dates; and discharge disposition for all PCI procedures performed in nonfederal hospitals in the state. Also included are lesion-specific information that identifies all diseased lesions, attempted lesions, and the stenosis before and after attempting PCI. Intended staged procedures are also reported at the initial procedure and at the time of the staged procedure. A procedure is regarded as staged only if it is reported at both of these times.
Data are audited for completeness and accuracy by matching to New York's acute care hospital administrative...