Comparing the use of coronary revascularization in France and the United States: Divergent trends

Background. – Coronary revascularization is a key treatment for coronary artery disease (CAD). Over the past 15 years, several randomized trials have shown that it failed to improve life expectancy in most patients with stable CAD.

Aim. – To compare trends in the use of coronary revascularization from 2012 to 2018 in France and the United States (US).

Methods. – Administrative databases were used in both countries to identify patients ≥ 35 years of age hospitalized for CAD or congestive heart failure (CHF) undergoing coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), as identified from the International Classification of Diseases coding system. Independent correlates of the use of coronary revascularization were also investigated.

Results. – In France, from 2012 to 2018, coronary revascularization increased by 13.3% among patients aged 35–64 years and by 24.6% among those aged ≥ 65 years. In contrast, in the US, it decreased by 16.3% and 19.6%, respectively. These trends were mainly related to the use of PCI: +15.8% and +28.8% in France versus –17.6% and –20.4% in the US. These divergent trends could not be explained solely by changes in the number of hospitalizations for CAD/CHF. In both countries and for both periods, use of revascularization was independently related to age, number of medical diagnoses, sex and income.

Conclusion. – Divergent trends in the use of coronary revascularization were observed in France and the US that could not be explained by trends in the number of CAD/CHF hospitalizations, nor by differences in the correlates of its use.