Trends in Coronary Revascularization and Ischemic Heart Disease-Related Mortality in Israel

Background:
This study investigated national trends in percutaneous coronary angioplasty (PCI), coronary artery bypass grafting (CABG) and ischemic heart disease (IHD)-related mortality in Israel.

Methods:
Using ICD-9 and 10 codes we linked 5 Israeli national databases: the Centers for Disease Control National PCI and CABG Registries, Ministry of Health Hospitalization Reports, Center of Bureau of Statistics and the Ministry of Interior Mortality Report to assess the annual PCI and CABG volume, procedural mortality, co-morbidities and IHD-related mortality between 2002 and 2014. Time trends were calculated assuming a Poisson distribution and linear regression.

Results: A total of 341,056 revascularization procedures (PCI-298,390, CABG-42,666) were performed during the study period. The volume of PCI increased by 9% from 2002 to 2008 (378.0/100K to 423.2/100K) and then steadily decreased to 378.5/100K in 2014 (p=0.70 for the trend). CABG volume decreased by 58% (109.0/100K to 45.8/100K) from 2002 to 2012 leveling during the last 3 years to 46.3/100K (p<0.0001). The PCI/CABG ratio increased from 3.6 in 2002 to 8.5 in 2012, slightly decreasing to 8.2 by 2014 (P<0.0001). In-hospital procedural mortality remained stable (PCI- 1.2-1.6%, p=0.34, CABG- 3.7-4.4%, p=0.29) despite a significant change in patient characteristics. During the study period, annual IHD-related mortality decreased by 46% (84.6 to 46/100K, p<0.001).

Conclusions:
We observed a dramatic change in coronary revascularization procedures volume and IHD-related mortality in Israel. Improvement in medical treatment, better patient selection related to data derived from large-scale clinical trials and adherence to appropriateness criteria, as well as improved procedural techniques and technology may account for these changes.