Key result
High hospital PCI volume (≥400/year) was associated with a lower unadjusted rate of in-hospital MACCE compared to low-volume hospitals (8.6% vs. 10.9%), but PCI volume was not an independent predictor after multivariate adjustment.
Why the study?
The relationship between hospital PCI volumes and in-hospital clinical outcomes in patients with AMI remains debated.
Does high hospital PCI volume improve in-hospital clinical outcomes in patients with acute myocardial infarction?
Cohort (n=17,121)
Yes
Does high hospital PCI volume improve in-hospital clinical outcomes in patients with acute myocardial infarction?
Absolute Event Rate: 8.6% vs 10.9%
p-value: p=0.001
Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with acute myocardial infarction, suggesting that other clinical and procedural factors may be more important drivers of outcomes.
Center selection by PCI volume alone may not optimize AMI outcomes; leaves open primacy of non-volume factors.
BACKGROUND AND OBJECTIVES: The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. METHODS: We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. RESULTS: Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. CONCLUSIONS: Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.
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Kim et al. (2020) conducted a cohort in Acute Myocardial Infarction (AMI) (n=17,121). High hospital PCI volume (≥400/year) vs. Low hospital PCI volume (<400/year) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE) during index admission (p=0.001). High hospital PCI volume (≥400/year) was associated with a lower unadjusted rate of in-hospital MACCE compared to low-volume hospitals (8.6% vs. 10.9%), but PCI volume was not an independent predictor after multivariate adjustment.
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