One-year mortality after surgical and non-surgical approaches to coronary revascularisation – results based on administrative data of a German health insurance

Abstract

Aims: In Germany, little is known about mortality of coronary revascularisation after discharge from hospital due to a lack of longitudinal population-based data. The availability of clinically relevant information in administrative health-insurance data increased during the last years. We determined the one-year mortality after surgical and non-surgical approaches to coronary revascularisation based on administrative data and explored the effectiveness of the available information for adjustment for confounders. Methods/Results: We analysed the one-year mortality of all beneficiaries of a German health insurance who underwent coronary artery bypass grafting or percutaneous coronary interventions in the year 2005 with complete follow-up (n=3447). We report the observed and the confounder adjusted one-year mortality (logistic regression). Parameters for adjustment for confounders (i.e. age, sex, previous myocardial infarction) were derived from administrative claims data on outpatient physician contacts, prescriptions, and hospital claims data up to ten years before and one year after discharge from the index procedure. The observed (and the adjusted) 1-year mortality was: CABG: 7.7% (8.4%), PTCA only: 6.2% (4.6%), PTCA and bare-metal stent: 5.0% (4.3%), PTCA and drug-eluting stent: 3.5% (3.9%). Conclusion: Adjustment for confounders based on administrative data accounted for the observed differences between the various percutaneous interventions, but the higher 1-year mortality after CABG remained unexplained.

Keywords

• mortality
• coronary revascularisation
• coronary artery bypass grafting
• percutaneous coronary intervention
• bare-metal stent
• drug-eluting stents