Heart disease is, by far, the leading cause of death in New York State (NYS), and the most common form of heart disease is atherosclerotic coronary artery disease. Various treatments are recommended for patients with coronary artery disease. For some people, changes in lifestyle, such as dietary changes, not smoking and regular exercise, can result in great improvements in health. In other cases, medication prescribed for high blood pressure or other conditions can make a significant difference.
Sometimes, however, an interventional procedure is recommended. e two most common procedures performed on patients with coronary artery disease are percutaneous coronary intervention (PCI), also known as percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass graft surgery (CABG).
During a PCI procedure, a catheter is threaded up to the site of the blockage in a coronary artery. In conjunction with the catheter, devices are used to open the blockage. In some cases, PCI is used as an emergency treatment for patients who are experiencing a heart attack or who may be in shock. Most cases, however, are not done on an emergency basis.
ose who have a PCI procedure are not cured of coronary artery disease; the disease can still occur in the treated blood
vessels or other coronary arteries. In order to minimize new blockages, patients should continue to reduce their risk factors for heart disease.
e analyses contained in this report are based on the information collected on each of the 164,792 patients who
underwent PCI in NYS hospitals and were discharged between January 1, 2006, and December 31, 2008. Analyses of risk-adjusted mortality rates and associated risk factors are provided for 2008 and for the three-year period from 2006 through 2008. Analyses of all cases, non-emergency cases (which represent the majority of procedures) and emergency cases are included.
e total number of PCI discharges in 2008, as reported in Table 1, was 54,990. is represents an increase from the
51,695 cases reported in 2007, but still a decrease from the 57,944 cases reported in 2006.
DEPARTMENT OF HEALTH PROgRAM
e New York State Department of Health (Department of Health) has been studying the effects of patient and
treatment characteristics on outcomes for patients with heart disease for nearly 20 years. Detailed statistical analyses of the information received from the study have been conducted under the guidance of the Cardiac Advisory Committee, a group of independent practicing cardiac surgeons, cardiologists and other professionals in related fields.
e results have been used to create a cardiac profile system that assesses the performance of hospitals and doctors over
time, taking into account the severity of each individual patient’s pre–operative conditions. Coronary artery bypass surgery results have been assessed since 1989; PCI results were released in 1996 for the first time.
Designed to improve health in people with heart disease, this program is aimed at:
understanding the health risks of patients that adversely affect how they will fare during and after PCI;
improving the results of different treatments of heart disease;
improving cardiac care; and
providing information to help patients make better decisions about their own care.
is report is based on data for patients discharged between January 1, 2006, and December 31, 2008, provided by all
54 non-federal hospitals in NYS where PCI is performed. Beginning with patients discharged in 2006, the Department of Health, with the advice of the Cardiac Advisory Committee, began a trial period of excluding any patients meeting the NYS Cardiac Data System definition of pre-operative cardiogenic shock from publicly released reports and analyses. Cardiogenic shock is a condition associated with severe hypotension (very low blood pressure); the technical definition used in this report can be found on Page 44. Patients in cardiogenic shock are extremely high-risk, but for some, PCI may be their best chance for survival. Furthermore, the magnitude of the risk is not always easily determined using registry data. ese cases were excluded after careful deliberation and input from NYS providers and others in an effort to ensure that physicians could accept these cases where appropriate without concern over a detrimental impact on their reported outcomes.