Coronary revascularisation in British Columbia: 25-year trends in volume and modality.

OBJECTIVE: Evaluate 25-year trends in coronary revascularization volumes and outcomes in British Columbia (BC). METHODS: All revascularizations in BC, Canada, between 2000-2024 were identified using provincial administrative datasets within the single-payer public health system serving 5.5 million persons. Cases were defined as any combination of PCI and/or CABG occurring within 60 days, categorized as One-Time PCI, Serial PCI, CABG, or Combination CABG + PCI. Temporal trends were assessed using linear regression and changepoint analysis. Statistical significance was set at α = 0.05. RESULTS: We identified 239,461 revascularization cases involving 563,994 vessel revascularizations. Annual case volumes per capita rose until 2005, remained stable until 2017, and then declined sharply (-9.06/100,000/year, p < 0.001). PCI and CABG accounted for 73.6% and 24.9% of cases, respectively. CABG use declined until the mid-2000s and stabilized thereafter at 25% of cases (15% for acute MI). Mean number of vessels treated per case increased modestly over time (+ 0.01 vessels/case/year, p = 0.003). Mean age at revascularization increased + 0.17 years/year (p < 0.001) from 67.2 to 71.1. Thirty-day mortality was 2.21%; 30-day CABG mortality declined annually (-0.04%/year, p < 0.001) from 2.14% to 1.46%, but PCI mortality increased (+ 0.05%/year, p < 0.001) from 1.60% to 2.46%. CONCLUSIONS: PCI has predominated since 2001, whereas CABG utilization stabilized after 2005. BC has experienced an ongoing revascularization recession since 2017.