Public reporting and case selection for percutaneous coronary interventions: An analysis from two large multicenter percutaneous coronary intervention databases

Mauro Moscucci, Kim A. Eagle, David Share, Dean Smith, Anthony C. De Franco, Michael O'Donnell, Eva Kline-Rogers, Sandeep M. Jani, David L. Brown

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

OBJECTIVES: The purpose of this research was to determine the potential effect of public reporting on case selection for percutaneous coronary intervention (PCI). BACKGROUND: Previous studies have suggested that public reporting of coronary artery bypass graft surgery (CABG) mortality might result in case selection bias and in denial of care to or out migration of high-risk patients. The potential effect of public reporting on case selection for PCI is unknown. METHODS: We compared demographics, indications, and outcomes of 11,374 patients included in a multicenter (eight hospitals) PCI database in Michigan where no public reporting is present, with 69,048 patients in a statewide (34 hospitals) PCI database in New York, where public reporting is present. The primary end point was in-hospital mortality. RESULTS: Patients in Michigan more frequently underwent PCI for acute myocardial infarction (14.4% vs. 8.7%, p < 0.0001) and cardiogenic shock (2.56% vs. 0.38%, p < 0.0001) than those in New York. The Michigan cohort also had a higher prevalence of congestive heart failure and extracardiac vascular disease. The unadjusted in-hospital mortality rate was significantly lower in New York than in Michigan (0.83% vs. 1.54%, p < 0.0001; odds ratio [OR] 0.54, 95% confidence interval [CI] 0.45 to 0.63). However, after adjustment for comorbidities, there was no significant difference in mortality between the two groups (adjusted OR 1.05, 95% CI 0.84 to 1.31, p = 0.70, c-statistic 0.88). CONCLUSIONS: There are significant differences in case mix between patients undergoing PCI in Michigan and New York that result in marked differences in unadjusted mortality rates. A propensity in New York toward not intervening on higher-risk patients because of fear of public reporting of high mortality rates is a possible explanation for these differences.

Original languageEnglish
Pages (from-to)1759-1765
Number of pages7
JournalJournal of the American College of Cardiology
Volume45
Issue number11
DOIs
StatePublished - Jun 7 2005

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Percutaneous Coronary Intervention
Databases
Mortality
Hospital Mortality
Odds Ratio
Confidence Intervals
Cardiogenic Shock
Selection Bias
Diagnosis-Related Groups
Emigration and Immigration
Vascular Diseases
Coronary Artery Bypass
Fear
Comorbidity
Heart Failure
Myocardial Infarction
Demography
Transplants
Research

ASJC Scopus subject areas

  • Nursing(all)

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Public reporting and case selection for percutaneous coronary interventions : An analysis from two large multicenter percutaneous coronary intervention databases. / Moscucci, Mauro; Eagle, Kim A.; Share, David; Smith, Dean; De Franco, Anthony C.; O'Donnell, Michael; Kline-Rogers, Eva; Jani, Sandeep M.; Brown, David L.

In: Journal of the American College of Cardiology, Vol. 45, No. 11, 07.06.2005, p. 1759-1765.

Research output: Contribution to journalArticle

Moscucci, Mauro ; Eagle, Kim A. ; Share, David ; Smith, Dean ; De Franco, Anthony C. ; O'Donnell, Michael ; Kline-Rogers, Eva ; Jani, Sandeep M. ; Brown, David L. / Public reporting and case selection for percutaneous coronary interventions : An analysis from two large multicenter percutaneous coronary intervention databases. In: Journal of the American College of Cardiology. 2005 ; Vol. 45, No. 11. pp. 1759-1765.
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abstract = "OBJECTIVES: The purpose of this research was to determine the potential effect of public reporting on case selection for percutaneous coronary intervention (PCI). BACKGROUND: Previous studies have suggested that public reporting of coronary artery bypass graft surgery (CABG) mortality might result in case selection bias and in denial of care to or out migration of high-risk patients. The potential effect of public reporting on case selection for PCI is unknown. METHODS: We compared demographics, indications, and outcomes of 11,374 patients included in a multicenter (eight hospitals) PCI database in Michigan where no public reporting is present, with 69,048 patients in a statewide (34 hospitals) PCI database in New York, where public reporting is present. The primary end point was in-hospital mortality. RESULTS: Patients in Michigan more frequently underwent PCI for acute myocardial infarction (14.4{\%} vs. 8.7{\%}, p < 0.0001) and cardiogenic shock (2.56{\%} vs. 0.38{\%}, p < 0.0001) than those in New York. The Michigan cohort also had a higher prevalence of congestive heart failure and extracardiac vascular disease. The unadjusted in-hospital mortality rate was significantly lower in New York than in Michigan (0.83{\%} vs. 1.54{\%}, p < 0.0001; odds ratio [OR] 0.54, 95{\%} confidence interval [CI] 0.45 to 0.63). However, after adjustment for comorbidities, there was no significant difference in mortality between the two groups (adjusted OR 1.05, 95{\%} CI 0.84 to 1.31, p = 0.70, c-statistic 0.88). CONCLUSIONS: There are significant differences in case mix between patients undergoing PCI in Michigan and New York that result in marked differences in unadjusted mortality rates. A propensity in New York toward not intervening on higher-risk patients because of fear of public reporting of high mortality rates is a possible explanation for these differences.",
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T2 - An analysis from two large multicenter percutaneous coronary intervention databases

AU - Moscucci, Mauro

AU - Eagle, Kim A.

AU - Share, David

AU - Smith, Dean

AU - De Franco, Anthony C.

AU - O'Donnell, Michael

AU - Kline-Rogers, Eva

AU - Jani, Sandeep M.

AU - Brown, David L.

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AB - OBJECTIVES: The purpose of this research was to determine the potential effect of public reporting on case selection for percutaneous coronary intervention (PCI). BACKGROUND: Previous studies have suggested that public reporting of coronary artery bypass graft surgery (CABG) mortality might result in case selection bias and in denial of care to or out migration of high-risk patients. The potential effect of public reporting on case selection for PCI is unknown. METHODS: We compared demographics, indications, and outcomes of 11,374 patients included in a multicenter (eight hospitals) PCI database in Michigan where no public reporting is present, with 69,048 patients in a statewide (34 hospitals) PCI database in New York, where public reporting is present. The primary end point was in-hospital mortality. RESULTS: Patients in Michigan more frequently underwent PCI for acute myocardial infarction (14.4% vs. 8.7%, p < 0.0001) and cardiogenic shock (2.56% vs. 0.38%, p < 0.0001) than those in New York. The Michigan cohort also had a higher prevalence of congestive heart failure and extracardiac vascular disease. The unadjusted in-hospital mortality rate was significantly lower in New York than in Michigan (0.83% vs. 1.54%, p < 0.0001; odds ratio [OR] 0.54, 95% confidence interval [CI] 0.45 to 0.63). However, after adjustment for comorbidities, there was no significant difference in mortality between the two groups (adjusted OR 1.05, 95% CI 0.84 to 1.31, p = 0.70, c-statistic 0.88). CONCLUSIONS: There are significant differences in case mix between patients undergoing PCI in Michigan and New York that result in marked differences in unadjusted mortality rates. A propensity in New York toward not intervening on higher-risk patients because of fear of public reporting of high mortality rates is a possible explanation for these differences.

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