Trends in rates, patient selection and prognosis of coronary revascularisations in Finland between 1994 and 2013: the CVDR.

ABSTRACT

AIMS: The aim of the study was to investigate the 20-year trends in rates, patient selection and prognosis of coronary revascularisations in Finland. METHODS AND RESULTS: We identified patients from nationwide registers who had undergone first-ever percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between 1994 and 2013. We examined changes in procedure rates, patient characteristics and estimated hazard ratios (HR) and 95% confidence intervals for cardiovascular events during this period. Between 1994 and 2013, 85,482 PCIs and 74,338 CABGs were performed. During this period, PCI rates more than quadrupled while CABG rates declined by two thirds. Between 1994-1998 and 2009-2013, the proportion of urgent procedures and mean patient age increased while the proportion of women remained stable. Although unadjusted mortality rose, the multivariable-adjusted HRs for 28-day mortality (PCI 0.62 [0.49-0.79]; CABG 0.62 [0.54-0.72]) and five-year incidence of cardiovascular death (PCI 0.72 [0.66-0.80]; CABG 0.77 [0.72-0.83]), myocardial infarction (PCI 0.47 [0.44-0.50]; CABG 0.31 [0.29-0.32]) and stroke (PCI 0.37 [0.34-0.40]; CABG 0.36 [0.33-0.38]) were lower in the last five-year period than in the period 1994-1998. CONCLUSIONS: Although revascularisation patients are older than before, post-procedural prognosis has improved drastically in recent years. Understanding the changing characteristics and prognosis of these patients is important for the interpretation of previous and future studies.