Why is this study important?

Percutaneous coronary intervention (PCI) is a safe and effective procedure for treating symptomatic coronary artery stenosis in patients with chronic coronary syndrome. Since 2020, the Centers for Medicare & Medicaid Services (CMS) has approved reimbursement for procedures performed in the ambulatory setting within ambulatory surgical centers (ASCs). Since then, there has been a growing trend towards performing this procedure in an ambulatory setting, with yet unanswered questions regarding patient characteristics, volume trends, procedure types, and outcomes.

What question was this study supposed to answer?

This publication sheds light on patient characteristics, volume trends, and outcomes in Medicare patients undergoing ambulatory PCI from 2020 to 2022 compared with patients receiving PCI in an outpatient (OP) hospital setting from 2018 to 2022.

What did the study show? 

• Using CPT codes, 480,060 patients were identified as having undergone PCI from 2020 to 2022
• Most patients (98.2%) received PCI in the hospital OP setting vs 1.8% in ACSs.
• The rate of PCIs being performed in ACSs is rising quickly, with 0.01/10,000 person-years in 2018 and 0.87/10,000 person-years in 2022.
• Socially vulnerable patients were more likely to be treated in ACSs (36.6% vs 21.9%) as were patients in the South (66.1% vs 44.5%). Patients with AMI within 1 year were less likely to be treated in ASCs (2.7% vs 6%)
• Multivessel PCI was less common in ACSs (3% vs 5.9%).
• 30-day rates of mortality, AMI, and stroke were < 2% in both groups. However, OP patients had higher rates of all-cause hospitalization, AMI, and bleeding. Need for repeat PCI was more common in patients treated in ASCs.