Evidence map›Paper›PMID 39248266›Full record

ArticleJournal of the American Heart Association2024

Hospital and Physician Variability in Revascularization Decisions and Outcomes for Patients With 3-Vessel and Left Main Coronary Artery Disease: A Population-Based Cohort Study.

Todd Wilson, Matthew T James, Danielle Southern, Bryan Har, Michelle M Graham, Neil Brass, Kevin Bainey, Paul W M Fedak, Tolulope T Sajobi, Stephen B Wilton

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Heart Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Association Between Interventional Cardiologist Practice Characteristics, Coronary Artery Bypass Grafting Use, and Clinical Outcomes.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026
    Observational
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Todd WilsonDepartment of Medicine University of Calgary Alberta Canada.ORCID 0000-0002-4345-0146
Matthew T JamesDepartment of Medicine University of Calgary Alberta Canada.ORCID 0000-0002-1876-3917
Danielle SouthernCentre for Health Informatics, Cumming School of Medicine University of Calgary Alberta Canada.ORCID 0000-0002-0006-0033
Bryan HarDepartment of Cardiac Sciences University of Calgary Alberta Canada.ORCID 0000-0003-2760-8967
Michelle M GrahamMazankowski Alberta Heart Institute, University of Alberta Edmonton Canada.ORCID 0000-0003-0708-7957
Neil BrassCKHui Heart Centre University of Alberta Alberta Canada.
Kevin BaineyMazankowski Alberta Heart Institute, University of Alberta Edmonton Canada.ORCID 0000-0002-5458-4617
Paul W M FedakDepartment of Cardiac Sciences University of Calgary Alberta Canada.
Tolulope T SajobiDepartment of Community Health Sciences University of Calgary Alberta Canada.ORCID 0000-0002-5696-5552
Stephen B WiltonDepartment of Community Health Sciences University of Calgary Alberta Canada.ORCID 0000-0002-6344-312X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHospital- and physician-level variation for selection of percutaneous coronary intervention versus coronary artery bypass grafting (CABG) for patients with coronary artery disease has been associated with outcome differences. However, most studies excluded patients treated medically. METHODS AND

resultsFrom 2010 to 2019, adults with 3-vessel or left main coronary artery disease at 3 hospitals (A, B, C) in Alberta, Canada, were categorized by treatment with medical therapy, percutaneous coronary intervention, or CABG. Multilevel regression models determined the proportion of variation in treatment attributable to patient, physician, and hospital factors, and survival models assessed outcomes including death and major adverse cardiovascular events over 5 years. Of 22 580 patients (mean age, 67 years; 80% men): 6677 (29%) received medical management, 9171 (41%) percutaneous coronary intervention, and 6732 (30%) CABG. Hospital factors accounted for 10.8% of treatment variation. In adjusted models (site A as reference), patients at sites B and C had 49% (95% CI, 44%-53%) and 43% (95% CI, 37%-49%) lower rates of medical therapy, respectively, and 31% (95% CI, 24%-38%) and 32% (95% CI, 24%-40%) lower rates of CABG. During 5.0 years median follow-up, 3287 (14.6%) patients died, with no intersite mortality differences. There were no between-site differences in acute coronary syndromes or stroke; patients at sites B and C had 24% lower risk (95% CI, 13%-34% and 11%-35%, respectively) of heart failure hospitalization.

conclusionsHospital-level variation in selection of percutaneous coronary intervention, CABG, or medical therapy for patients with complex coronary artery disease was not associated with differences in 5-year mortality rates. Research and quality improvement initiatives comparing revascularization practices should include medically managed patients.

Indexed as

Coronary Artery BypassCoronary Artery DiseasePercutaneous Coronary InterventionAgedAlbertaClinical Decision-MakingFemaleHospitalsHumansMaleMiddle AgedPractice Patterns, Physicians'Risk FactorsTreatment Outcomecoronary artery diseasedeathpractice variationrevascularization

Identifiers

PMID39248266
PMCPMC11935616

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.