Yonsei Med J.  2015 Jul;56(4):895-903. 10.3349/ymj.2015.56.4.895.

Changes in the Practice of Coronary Revascularization between 2006 and 2010 in the Republic of Korea

• Choi YJ
• Kim JB
• Cho SJ
• Cho J
• Sohn J
• Cho SK
• Ha KH
• Kim C

• KMID: 2366327
• DOI: http://doi.org/10.3349/ymj.2015.56.4.895

Abstract

PURPOSE
Evidence suggests that technological innovations and reimbursement schemes of the National Health Insurance Service may have impacted the management of coronary artery disease. Thus, we investigated changes in the practice patterns of coronary revascularization.
MATERIALS AND METHODS
Revascularization and in-hospital mortality among Koreans > or =20 years old were identified from medical claims filed between 2006 and 2010. The age- and sex-standardized procedure rate per 100000 person-years was calculated directly from the distribution of the 2008 Korean population.
RESULTS
The coronary revascularization rate increased from 116.1 (95% confidence interval, 114.9-117.2) in 2006 to 131.0 (129.9-132.1) in 2010. Compared to the rate ratios in 2006, the rate ratios for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in 2010 were 1.16 (1.15-1.17) and 0.80 (0.76-0.84), respectively. Among patients who received PCI, the percentage with drug-eluting stents increased from 89.1% in 2006 to 93.0% in 2010. In-hospital mortality rates from PCI significantly increased during the study period (p=0.03), whereas those from CABG significantly decreased (p=0.01). The in-hospital mortality rates for PCI and CABG were higher in elderly and female patients and at the lowest-volume hospitals.
CONCLUSION
The annual volume of coronary revascularization continuously increased between 2006 and 2010 in Korea, although this trend differed according to procedure type. A high percentage of drug-eluting stent procedures and a high rate of in-hospital mortality at low-volume hospitals were noted.

Keyword

Myocardial revascularization; percutaneous coronary intervention; insurance; reimbursement

MeSH Terms

Adult
Aged
Aged, 80 and over
Coronary Artery Bypass/*statistics & numerical data/trends
Coronary Artery Disease/*surgery
Drug-Eluting Stents
Female
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Revascularization/*methods/*trends
Percutaneous Coronary Intervention/*statistics & numerical data/trends
Republic of Korea/epidemiology

Figure

• 

  Fig. 1 Quarterly distribution of the number of percutaneous coronary intervention (PCI) procedures according to the type of procedure from 2006 to 2010 in the Republic of Korea. BMS, bare-metal stent; DES-1G, first-generation drug-eluting stent; DES-2G, second-generation drug-eluting stent; DES-3G, third-generation drug-eluting stent.

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