Coronary revascularization in France: Six-year trends and outcomes in coronary artery bypass grafting and percutaneous coronary intervention.

Abstract

This study aimed to analyze temporal trends in coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in France from 2017 to 2022. A retrospective analysis of all isolated CABG and PCI procedures was conducted using data from the French national hospital discharge database. During the study period, 109,792 CABG and 1,228,509 PCI procedures were performed. CABG volumes declined by 9.7%, whereas PCI increased by 11.8%, resulting in a 24.4% increase in the PCI-to-CABG ratio (from 9.8 to 12.2). The sharpest inflection occurred in 2020, with a pandemic-related procedural decrease of 14.9% for CABG and 5.3% for PCI. CABG procedures involving 3 or ≥4 distal anastomoses increased by 5.8% and 17.7%, respectively, whereas the use of multiple arterial grafts increased to 72.2% in 2022. PCI volumes increased across all categories, particularly for multivessel interventions. In-hospital mortality for elective CABG decreased from 1.5% to 1.3% (-13.3%), whereas PCI mortality remained stable (0.5%). In emergency settings, mortality declined by 7.7% for PCI (3.1% to 2.8%) and 35.1% for CABG (4.6% to 3.0%). Between 2017 and 2022, France experienced a sustained shift toward PCI and declining CABG volumes, which was amplified during the COVID-19 pandemic. Despite this, CABG outcomes improved, with broader adoption of extensive revascularization strategies and arterial grafting. These findings underscore the need for ongoing surveillance of national practice patterns to ensure evidence-based coronary care.