Comparative clinical outcomes and mortality risk in coronary artery bypass grafting, valve surgeries, and percutaneous interventions.

Abstract

Objectives: Coronary artery disease and valvular heart disease are leading causes of mortality globally. This study aimed to investigate the correlation between expected mortality rates (EMRs) and observed mortality rates (OMRs) for common cardiac interventions using recent national data on percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and cardiac valve surgeries.

Methods: This multi-institutional, retrospective observational study analyzed in-hospital/30-day mortality outcomes for 106,836 patients who underwent PCI, CABG, or cardiac valve procedures across 64 non-federal hospitals in New York State between December 2012 and November 2015. The procedures included emergency and non-emergency PCI, CABG, valve or valve-CABG surgeries, and transcatheter aortic valve replacement (TAVR).

Results: Among the 106,836 patients, a 3.21% 30-day mortality rate was observed (n=3,436). To assess the disparity between OMR and EMR, a one-sample t-test was performed. Effect sizes were determined using Cohen's d and Hedges' correction. With a 95% confidence interval, the t-value for the OMR (mean difference =2.037±1.728, CI: 1.95-2.12) was 47.270, whereas the EMR (mean difference =1.930±1.284, CI: 1.86-1.99) yielded a t-value of 60.279. The OMR was significantly greater than the EMR (P<0.001).

Conclusion: The OMR was significantly greater than the EMR across all cardiac procedures, suggesting potential influences from patient demographics, comorbidities, and variations in hospital practices. Further research is needed to understand these factors and improve the quality of cardiac care.