Key result
PCI performed at high-volume hospitals (>325 PCIs/year) was associated with lower in-hospital mortality compared to low-volume hospitals (OR 0.67; 95% CI 0.52-0.87; P=0.002).
Why the study?
Does PCI performed at high-volume hospitals reduce in-hospital mortality in patients undergoing PCI?
Observational (n=27,965)
Yes
Does PCI performed at high-volume hospitals reduce in-hospital mortality in patients undergoing PCI?
Effect estimate: OR 0.67 (95% CI 0.52 to 0.87)
Absolute Event Rate: 1.21% vs 1.85%
p-value: p=0.002
Higher hospital PCI volume is associated with lower in-hospital mortality, particularly for high-risk patients presenting with acute myocardial infarction.
Supports volume-based PCI referral for high-risk cases; leaves open whether this association is causal or should guide policy.
Objective: The formerly observed volume–outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned. Design: We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Patients: In 2003 a total of 27 965 patients at 67 hospitals were included. Results: The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction. Conclusions: This analysis of contemporary PCI in clinical practice shows a small but significant volume–outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.
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Zahn et al. (2007) conducted an observational in Percutaneous coronary interventions (PCI) (n=27,965). PCI at high-volume hospitals (>325 PCIs/year) vs. PCI at low-volume hospitals (<325 PCIs/year) was evaluated on In-hospital mortality (OR 0.67, 95% CI 0.52 to 0.87, p=0.002). PCI performed at high-volume hospitals (>325 PCIs/year) was associated with lower in-hospital mortality compared to low-volume hospitals (OR 0.67; 95% CI 0.52-0.87; P=0.002).
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