COMPARATIVE ANALYSIS OF PERCUTANEOUS REVASCULARIZATION PRACTICE IN THE UNITED STATES AND THE UNITED KINGDOM: INSIGHTS FROM THE BMC2 AND BCIS DATABASES

Abstract

Background: We compared clinical practice patterns, procedural outcomes, and trends in percutaneous coronary intervention (PCI) utilization using a state-wide PCI registry in the United States and a national registry from the United Kingdom (UK).

Methods: We analyzed all PCI cases from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium and the British Cardiovascular Intervention Society registries from 2010-2017. Procedural characteristics and in-hospital outcomes were stratified by PCI indication.

Results: 248,283 cases were performed in Michigan (MI) and 773,083 in the UK during the study period. The proportion of patients with a prior diagnosis of diabetes in MI was nearly double that in the UK (38.9% vs. 21.0%). Primary PCI was more frequent in the UK (25% UK vs. 14.3% MI). Radial access increased in both registries (86.8% in the UK vs. 45.1% in MI the final year of the study). Mechanical support fell to 0.9% of cases in the UK and rose to 3.95% of cases in MI in 2017. Unadjusted crude mortality rates were similar, with higher rates of post-PCI transfusion and other complications in the Michigan population.

Conclusion: While overall outcomes are broadly similar, there are significant differences in PCI practice between the US and UK. Notable findings include a marked difference in diabetes prevalence, a greater proportion of primary PCI and more robust adoption of transradial PCI in the UK. Mechanical support increased during the study period in Michigan and declined in the UK.