Trends in cardiac surgery and percutaneous interventions in New York: a statewide registry analysis (2010-2019)

Abstract

Background: Contemporary practice in coronary and valve interventions continues to evolve with changing indications, technology, and systems of care. I characterized statewide procedure volumes and mortality for PCI, CABG, Valve ± CABG, and TAVR using a unified, internally consistent analytic framework.

Methods: I analyzed New York State public-use registry data (2010-2019). All PCI and Non-Emergency PCI are reported annually. Emergency PCI was derived annually at the hospital-year level as All PCI - Non-Emergency PCI; deaths and expected deaths were derived by subtraction and aggregated statewide. CABG is reported annually. Valve ± CABG and TAVR are provided as overlapping 3-year windows; I produced annualized values by averaging the per-year contribution from the two windows that include each year (single window at edges; TAVR available 2013-2019). Statewide Observed %, Expected %, O/E, and Risk-Adjusted % were computed as case-weighted aggregates. No hypothesis testing was performed.

Results: From 2010 to 2019, there were 1,005,980 PCI and 171,182 CABG procedures statewide. Overall PCI volume was stable (2010: 108,070; 2019: 108,552). Within PCI, Non-Emergency comprised 835,480 (83.1%) and Emergency 170,500 (16.9%); non-emergency PCI declined modestly (2010: 93,498 → 2019: 89,654), while emergency PCI increased (2010: 14,572 → 2019: 18,898). CABG volumes were broadly stable (2010: 18,842 → 2019: 17,876). Annualized Valve ± CABG volumes declined (≈ 14,822 in 2010 → 11,893 in 2019), whereas TAVR expanded after introduction (2013: 3,703 → 2019: 9,963). Pooled risk-adjusted mortality: All PCI 1.11%, Non-Emergency PCI 0.72%, Emergency PCI 3.07%, CABG 1.53%, Valve ± CABG 3.27% (2010-2019), and TAVR 2.93% (2013-2019). Across procedures and years, O/E ≈ 1.00, indicating good model calibration.

Conclusions: Between 2010 and 2019, statewide PCI volume was stable; non-emergency PCI declined modestly, emergency PCI rose modestly, CABG volumes were broadly stable, Valve ± CABG decreased, and TAVR increased substantially with improving mortality. Overall PCI mortality remained low and largely stable, consistent with higher-risk case mix over time. These contemporary benchmarks can inform quality improvement, capacity planning, and policy while highlighting the need for continued monitoring of high-risk PCI pathways and long-term TAVR durability in younger patients.

Keywords: CABG; Newyork cardiac Registry; Percutaneous coronary interventions; Risk-adjusted mortality; TAVR.

Fig. 1

Annual case volumes (2010–2019). Overall PCI is stable; the emergency PCI share rises modestly as non-emergency PCI plateaus/slightly declines; CABG is broadly stable; valve interventions shift toward rapid TAVR growth with a concurrent decline in valve ± CABG

Fig. 2

Annual risk-adjusted mortality (2010–2019; TAVR from 2013). Valve ± CABG and TAVR show sustained declines; non-emergency PCI remains low; CABG varies within a narrow band; emergency PCI is higher with a modest mid-decade uptick followed by a plateau

Fig. 3

Pooled risk-adjusted mortality by procedure (2010–2019; TAVR from 2013). A clear gradient is seen: non-emergency PCI is lowest, all PCI remains low, CABG is intermediate, TAVR is higher, and valve ± CABG and emergency PCI are highest