Trends in Use of Coronary Angiography, Percutaneous Coronary Intervention, and Coronary Artery Bypass Graft Over a Decade in France: A Nationwide Cohort Study.
Hauguel-Moreau M, Weizman O, et al. • Journal of the American Heart Association • 2026
Over 2014-2023 in France, annual coronary interventions rose 33% (coronary angiography +32%, PCI +40%, CABG -8%), with PCI growth driven by elective procedures in older patients, while in-hospital mortality after PCI and CABG declined.
Key Findings
Results
The annual number of coronary interventions in France increased by 33% over 10 years, driven by increases in coronary angiography and PCI, while CABG decreased.
Data came from the French National Hospitalization Database, 2014 to 2023, covering a population of 67.0 million inhabitants.
A total of 6,290,951 coronary interventions were analyzed among 2,985,822 patients (mean age 67.8±12.2 years; 69.9% men).
Coronary angiography increased by 32% and PCI by 40%, whereas coronary artery bypass graft decreased by 8%.
Results
The growth in PCI was predominantly due to an increase in elective procedures, particularly among older patients.
The share of elective PCI rose from 53.5% to 56.9% (P<0.001).
PCI among older patients increased by 73%.
The authors state the trend was seen particularly in procedures classified as elective among older patients.
Results
PCI was increasingly performed in patients with multivessel disease.
Multivessel disease share rose from 16.7% in 2014-2015 to 19.0% in 2022-2023 (P<0.001).
Results
Attempts to recanalize chronic total coronary occlusion nearly doubled over the decade.
The proportion rose from 1.9% to 3.3% (P<0.001).
Results
In-hospital death after PCI decreased over the decade, with the most notable improvements in nonelective PCI.
In-hospital mortality after PCI fell from 2.05% in 2014 to 1.58% in 2023 (P for trend<0.001).
The largest improvements were observed in nonelective PCI.
Results
In-hospital death after CABG also declined over the decade.
In-hospital mortality after CABG decreased from 3.5% to 2.9% (P<0.001).
Conclusions
The authors conclude the rise in angiography and PCI, especially elective PCI in older patients, raises questions about how recent scientific evidence and guidelines influence clinical practice in France.
The trends were observed despite evidence and guidelines emerging over the period.
The study is a descriptive nationwide analysis of administrative hospitalization data.
What This Means
This study used France's national hospital database to look at how often heart artery procedures were done between 2014 and 2023. It covered more than 6 million procedures in about 3 million patients. The yearly number of procedures rose by about one-third. Coronary angiography (imaging of the heart arteries) rose 32%, and stenting or balloon procedures (PCI) rose 40%. Bypass surgery (CABG) fell by 8%.
Most of the increase in PCI came from planned (elective) procedures, especially in older patients, where PCI rose 73%. Procedures were also more often done in patients with disease in several vessels, and attempts to open completely blocked arteries nearly doubled, from 1.9% to 3.3%. At the same time, deaths in hospital after PCI fell from 2.05% to 1.58%, and deaths in hospital after bypass surgery fell from 3.5% to 2.9%. The biggest improvements were seen in emergency PCI.
This research suggests that heart procedures in France are growing and shifting toward more planned procedures in older patients, while short-term hospital survival has improved. The authors say the trend raises questions about how recent scientific evidence and guidelines affect real-world practice. Because the study describes trends in hospital records, it cannot show why the changes happened or whether each procedure was appropriate.
Hauguel-Moreau M, Weizman O, Majois V, Mansencal N, Marijon E, Danchin N, et al.. (2026). Trends in Use of Coronary Angiography, Percutaneous Coronary Intervention, and Coronary Artery Bypass Graft Over a Decade in France: A Nationwide Cohort Study.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047221