Practice of coronary angioplasty in California in 1995 : comparison to 1989 and impact of coronary stenting.

BACKGROUND This study seeks to analyze changes in the practice of PTCA in California between 1989 and 1995 by use of the Office of Statewide Health Planning and Development (OSHPD) data set. METHODS AND RESULTS All hospital discharges in 1995 with a procedure code for PTCA or stent were identified. The 1995 PTCA data were compared with previously published data from 1989 obtained from the same database. The number of PTCAs performed increased by 49% between 1989 and 1995, from 24 883 to 37 118. The percentage of female patients increased from 29.8% to 32.7% (P=0.0001). The percentage of diabetics increased from 14.4% to 21.6% (P=0.0001) between 1989 and 1995. Procedures on patients with a principal diagnosis of acute myocardial infarction increased from 19.3% of all PTCAs in 1989 to 27.5% of PTCAs in 1995 (P=0.0001). In-hospital mortality increased from 1.4% in 1989 to 1.9% in 1995 (P=0.0001). There were 3087 admissions with stent placement in 1995. In-hospital mortality after stent placement was 0.9% (P=0.0001 versus PTCA). Patients undergoing PTCA in hospitals performing >400 PTCAs in 1995 had a 4% incidence of death or emergency bypass surgery compared with a 6% incidence when PTCAs were performed in hospitals performing 75 stent procedures in 1995 had a 1.3% incidence of death or emergency bypass compared with an incidence of 4% when the procedure was performed in a hospital performing </=75 stent placements in 1995 (P<0.0001). CONCLUSIONS The 1995 OSHPD data continue to suggest an inverse relationship between hospital PTCA and stent volume and adverse patient outcomes.