Background: During the past decade, percutaneous coronary intervention (PCI) has increased dramatically compared with coronary artery bypass grafting (CABG) for patients with coronary artery disease. However, although the evidence available to all practitioners is similar, the relative distribution of PCI and CABG appears to differ among countries.
Objectives: To compare national trends in the rates and types of coronary revascularization with other developed countries.
Methods: We reviewed published data from Israel and OECD (Organization for Economic Co-operation and Development) countries. Revascularization data in Israel were retrieved from the Israel Center for Disease Control, affiliated to the Ministry of Health; OECD data from the official OECD published report, and USA data from official reports published by each state.
Main Outcome Measures: Annual procedure rates of total coronary revascularizations, CABG and PCI.
Results: In Israel between 2009 and 2012 annual revascularization rates per 1 million remained stable, while PCI rates increased from 87.2% to 89.6% of total revascularizations, and CABG decreased from 12.8% to 10.4%. Between 2009 and 2012, the PCI/CABG rate increased by 26% (6.84 to 8.59). In Israel the highest PCI/CABG rate was 6.84 as opposed to 3.3 (2008 data) in all other OECD countries. The most recent official data from NewYork, New Jersey, Massachusetts and California for PCI/CABG rates are: 5.25, 5.71, 4.5 and 3.7, respectively, as opposed to 8.5 in Israel (2011 and 2012).
Conclusions: There are substantial differences in the utilization of PCI versus CABG among cardiac centers in Israel versus other countries, possibly related to patient characteristics, physician bias and culture. Understanding these disparities may facilitate the selection of the most appropriate, effective and evidence-based revascularization strategy.
