Comparing the use of coronary revascularization in France and the United States: Divergent trends - 24/03/26

Doi : 10.1016/j.acvd.2026.02.002

Michael K. Gusmano ^a, Victor G. Rodwin ^b, Daniel Weisz ^c, Jonathan Cottenet ^d,^e, Nicolas Danchin ^f,⁎ , Catherine Quantin ^d,^e,^g,^h,ⁱ

^a College of Health, Lehigh University, Bethlehem, PA 18015, United States

^b Wagner School of Public Service, New York University, New York, NY 10003, United States

^c R.N. Butler Columbia Aging Center, Columbia University, New York, NY 10032, United States

^d Biostatistics and Bioinformatics (DIM), University Hospital, 21000 Dijon, France

^e Bourgogne Franche-Comté University, 21000 Dijon, France

^f Department of Cardiology, Hôpital Saint Joseph, 75014 Paris, France

^g Inserm, CIC 1432, 21000 Dijon, France

^h Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, 21000 Dijon, France

ⁱ Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, 94807 Villejuif, France

^⁎ Corresponding author. Service de Cardiologie, Hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France. Service de Cardiologie, Hôpital Saint-Joseph 185, rue Raymond-Losserand Paris 75014 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 24 March 2026

Graphical abstract

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Highlights

•	Coronary revascularization does not generally improve survival in stable CAD.
•	Trends in the use of CABG and PCI from 2012 to 2018 were compared in France and the US.
•	Revascularization increased by 19.1% in France but decreased by 17.9% in the US, driven by PCIs.
•	Trends were comparable for patients aged 35–64 and ≥ 65 years.
•	French trends do not follow scientific knowledge and likely increase health expenditure.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Coronary revascularization is a key treatment for coronary artery disease (CAD). Over the past 15 years, several randomized trials have shown that it failed to improve life expectancy in most patients with stable CAD.

Aim

To compare trends in the use of coronary revascularization from 2012 to 2018 in France and the United States (US).

Methods

Administrative databases were used in both countries to identify patients ≥ 35 years of age, hospitalized for CAD or congestive heart failure (CHF) undergoing coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), as identified from the International Classification of Diseases coding system. Independent correlates of the use of coronary revascularization were also investigated.

Results

In France, from 2012 to 2018, coronary revascularization increased by 13.3% among patients aged 35–64 years and by 24.6% among those aged ≥ 65 years. In contrast, in the US, it decreased by 16.3% and 19.6%, respectively. These trends were mainly related to the use of PCI: +15.8% and +28.8% in France versus–17.6% and–20.4% in the US. These divergent trends could not be explained solely by changes in the number of hospitalizations for CAD/CHF. In both countries and for both periods, use of revascularization was independently related to age, number of medical diagnoses, sex and income.

Conclusion

Divergent trends in the use of coronary revascularization were observed in France and the US that could not be explained by trends in the number of CAD/CHF hospitalizations, nor by differences in the correlates of its use.

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Keywords : France, United States, Coronary revascularization, Sex

Abbreviations : ACA, AHRQ, CABG, CAD, CHF, HCUP, ICD-9-CM, ICD-10-CM, ICD-9-PCS, ICD-10-PCS, NIS, PCI, PMSI, US