California Cardiac Surgery Intervention Project

Summary of California-wide Trends in Cardiac Procedures - MACCE within 90 Days after Cardiac Surgery / Intervention

The Multiple Adverse Cardiac and Cerebrovascular Events within 90 Days (MACCE-90) outcome is based on multiple adverse events after the cardiac procedure: 1. Death; 2. Post-Op Stroke; 3. Post-Op Acute MI; 4. Re-Intervention. The MACCE-90 outcome shown in this summary is based on adverse events a patient experienced in the surgery/intervention admission, subsequent through-a-transfer connected acute care admissions or acute care inpatient re-admissions within 90 days of the index surgery / intervention.

MACCE-90 after Cardiac Procedures, California, 2012-2013

Cardiac ProcedureNumber of ProceduresNumber of EventsEvent Rate
Isolated CABG 20,732 1,773 8.6
CABG/Valve 4,949 626 12.7
Isolated Valve 10,918 867 7.9
PCI with ACS 43,139 6,269 14.5
PCI without ACS 38,873 3,485 9.0

Looking at Multiple Adverse Cardiac and Cerebrovascular Events within 90 Days after Isolated CABG surgery, MACCE-90 decreased slightly from 1999 to 2013; compared to the MACCE based on the index admission and subsequent connected admissions only, this trend is less pronounced. For CABG/Valve surgery the MACCE-90 rate decreased by almost 5% from 1999 to 2008 and subsequently increased slightly. For Isolated Valve surgery the MACCE-90 rate decreased steadily through the study period. The MACCE-90 rate after PCI with ACS decreased from 1999 to 2013. The MACCE-90 rate after PCI without ACS decreased from 1999 to 2006, but rose to higher levels after 2006.

 MACCE-90 Trend, 1999-2013

Using the level of Multiple Adverse Cardiac and Cerebrovascular Events within 90 days of the cardiac procedure observed in 2012-2013 as a standard, MACCE-90 after isolated CABG surgery decreased from 1999 to 2009 with similar mortality levels thereafter. A breakdown of the type of adverse event indicates that re-interventions contributed 23% and mortality contributed 28% to MACCE-90 events in 2013. Interesting is the larger percentage of multiple adverse events in the MACCE-90 in 2013 (15%) compared to the MACCE rate (9%). Note that for all the charts below the number of adverse events for 2013 is affected by the truncated follow-up period as the MACCE-90 has to be calculated based on surgeries that were performed through October 2, 2013.

 Risk-Adjusted Rate Trend, 1999-2013

 Adverse Events Contributing to MACCE-90, 1999-2013

MACCE-90 after isolated valve surgery steadily decreased from 1999 to 2011. In 2013, the most important components of the MACCE-90 rate were mortality and post-op stroke.

 Risk-Adjusted Rate Trend, 1999-2013

 Adverse Events Contributing to MACCE-90, 1999-2013

The MACCE-90 rate after CABG/Valve surgery decreased from 1999 to 2008, then continued at similar levels through 2013. The mortality and stroke components drove 71% of adverse events measured through the MACCE-90.

 Risk-Adjusted Rate Trend, 1999-2013

 Adverse Events Contributing to MACCE-90, 1999-2013

The incidence of MACCE-90 in PCIs with ACS decreased steadily from 1999 to 2012, then held steady at 2012 levels in 2013. As the MACCE rate, the MACCE-90 rate for PCIs with ACS was driven primarily by non-elective re-interventions followed by mortality which together accounted for 87% of MACCE-90 adverse events.

 Risk-Adjusted Rate Trend, 1999-2013

 Adverse Events Contributing to MACCE-90, 1999-2013

The incidence of MACCE-90 in PCIs without ACS decreased from 1999 to 2006, increased from 2006 to 2008, then reached its lowest levels in 2012 and 2013. The MACCE-90 for PCIs without ACS was driven primarily by non-elective re-interventions and acute MIs. Post-Op Strokes were relatively rare.

 Risk-Adjusted Rate Trend, 1999-2013

 Adverse Events Contributing to MACCE-90, 1999-2013

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Last updated: 02/21/2015

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