Summary of California-wide Trends in Cardiac Procedures - Mortality after Cardiac Surgery / Intervention

For PCIs, the Multiple Adverse Cardiac and Cerebrovascular Events (MACCE) outcome is based on death, post-operative stroke, post-operative acute myocardial infarction or unplanned re-intervention > 30 days of the index PCI during the index admission, or during acute care non-elective admissions following transfer after the index surgery/intervention that are connected to the index admission.

For the surgery groups, the Multiple Adverse Cardiac and Cerebrovascular Events (MACCE) outcome is based on death, post-operative stroke, post-operative acute myocardial infarction or re-intervention during the index admission or during acute care admissions following transfer after the index surgery/intervention that are connected to the index admission.

Note that any events that occurred after a patient left the acute care setting - or for PCIs only, the ambulatory surgery setting - are not included.

MACCE after Cardiac Procedures, California, 2020-2021

Multiple Adverse Cardiac and Cerebrovascular Events after isolated CABG surgery, isolated Surgical AV-Replacement, MV-Replacement or MV-Repair with or without CABG decreased from 1999 to 2019. In 2020 and 2021, for these surgery, MACCE was higher than in 2019.

Transcatheter AV-Replacements, after an initially very high MACCE level in 2011, show a dramatic decrease from 12.2% in 2011 to the lowest MACCE % observed across all surgery/intervention groups of 2.45% in 2020. The MACCE % after PCI with and without ACS increased from 4.2% / 2.3% in 1999 to 6.2% / 3.1% in 2021.

Using the level of Multiple Adverse Cardiac and Cerebrovascular Events observed in 2020-2021 as a standard, the casemix-adjusted MACCE after isolated CABG surgery has decreased from 1999 to 2019 with similar levels as in 2019 for 2020 and 2021. A breakdown of the type of adverse event indicates that mortality and post-operative stroke are the largest contributors to the MACCE for almost every year.

The casemix-adjusted MACCE after isolated Surgical AV-Replacement, MV-Replacement or MV-Repair steadily decreased from 1999 to 2019 and plateaued thereafter. Mortality and stroke are the biggest contributors to MACCE events accounting for 80% of MACCE endpoints in 2021.

The casemix-adjusted MACCE after TAVR significantly decreased from 2011 to 2019 remaining at levels similar to 2019 in 2020 and 2021. Stroke and mortality were the biggest contributors among the MACCE events.

The trend in the casemix-adjusted MACCE after isolated Surgical AV-Replacement, MV-Replacement or MV-Repair shows a steady decline for most years from 1999 to 2019. For isolated Surgical AV-Replacement, MV-Replacement or MV-Repair with CABG, the mortality component drove 55.9% of adverse events measured through the MACCE in 2021.

The casemix-adjusted MACCE in PCIs with ACS mostly decreased from 1999 to 2013, but then increased most years in the subsequent period through 2021. The MACCE for PCIs with ACS was driven primarily by mortality accounting for 76% of MACCE events followed by post-op stroke.

The casemix-adjusted MACCE in PCIs without ACS increased most years from 2000 to 2013 (4.14%). Since 2013, casemix-adjusted MACCE in PCIs without ACS decreased to reach its lowest level in 2017 and remained at this level for later years. The MACCE for PCIs without ACS was driven primarily by post-op acute MIs (45.5% of MACCE outcomes), followed by mortality (24.6% of MACCE outcomes). Unplanned re-interventions alone were very rare. For PCIs without ACS, multiple adverse events accounted for 18.1% of MACCE outcomes.