What does this research mean for the field?

Higher volumes of primary angioplasty procedures performed by physicians and hospitals for acute myocardial infarction are associated with significantly lower in-hospital mortality rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate whether physician and hospital procedural volumes correlate with in-hospital mortality among patients undergoing primary angioplasty for acute myocardial infarction.

October 30, 2001Circulation

Volume-Outcome Relation for Physicians and Hospitals Performing Angioplasty for Acute Myocardial Infarction in New York State

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute Myocardial Infarction (n=1342). Intervention: Primary angioplasty by high-volume physicians vs. Primary angioplasty by low-volume physicians. Primary outcome: In-hospital mortality (RR 0.43, 95% CI 0.21 to 0.83).

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Key result

Primary angioplasty performed by high-volume physicians reduced in-hospital mortality by 57% compared to low-volume physicians (adjusted RR 0.43; 95% CI 0.21 to 0.83).

Why the study?

Does primary angioplasty performed by high-volume physicians and hospitals reduce in-hospital mortality in patients with acute myocardial infarction?

Population

1,342 patients who underwent primary angioplasty within 23 hours of onset of acute myocardial infarction…

Comparison

Primary angioplasty performed by high-volume… vs Primary angioplasty performed by low-volume…

Design

Cohort

Follow-up

In-hospital

Authors

BVBabak VakiliIslamic Azad University, Tehran RKRobert C. KaplanGeneral / Preventive / Lipids DBDavid BrownBoston University

Discussion

Member takes

Implication

May improve AMI survival with high-volume operators; extends prior volume-outcome data but leaves practice change open.

Key Points

To evaluate whether physician and hospital procedural volumes correlate with in-hospital mortality among patients undergoing primary angioplasty for acute myocardial infarction.
Analyzed registry data from the 1995 New York State Coronary Angioplasty Reporting System Registry.
Identified 1,342 patients who underwent primary angioplasty within 23 hours of acute myocardial infarction onset without receiving prior thrombolytic therapy.
Primary angioplasty performed by high-volume physicians reduced in-hospital mortality by 57% compared with low-volume physicians (adjusted relative risk 0.43; 95% CI, 0.21 to 0.83).
Treatment at high-volume hospitals was associated with a 44% reduction in the risk of in-hospital mortality compared with low-volume institutions (adjusted relative risk 0.56; 95% CI, 0.29 to 1.10).
Patients treated by high-volume physicians at high-volume hospitals exhibited a 49% reduction in in-hospital mortality relative to those treated by low-volume physicians at low-volume hospitals (adjusted relative risk 0.51; 95% CI, 0.26 to 0.99).

Study Design

Type

Observational (n=1,342)

Multicenter

Yes

Structured PICO

Does primary angioplasty performed by high-volume physicians and hospitals reduce in-hospital mortality in patients with acute myocardial infarction?

Population

1,342 patients who underwent primary angioplasty within 23 hours of onset of acute myocardial infarction without preceding thrombolytic therapy in New York State in 1995

Intervention

Primary angioplasty performed by high-volume physicians and/or high-volume hospitals

Comparator

Primary angioplasty performed by low-volume physicians and/or low-volume hospitals

Outcome

In-hospital mortalityhard clinical

Main Result

Effect estimate: RR 0.43 (95% CI 0.21 to 0.83)

Higher volume of primary angioplasty procedures performed by physicians and/or hospitals is associated with a significantly lower in-hospital mortality rate for patients with acute myocardial infarction.

Cite This Study

Vakili et al. (2001) conducted an observational in Acute Myocardial Infarction (n=1,342). Primary angioplasty by high-volume physicians vs. Primary angioplasty by low-volume physicians was evaluated on In-hospital mortality (RR 0.43, 95% CI 0.21 to 0.83). Primary angioplasty performed by high-volume physicians reduced in-hospital mortality by 57% compared to low-volume physicians (adjusted RR 0.43; 95% CI 0.21 to 0.83).

synapsesocial.com/papers/6a0f34fc68065d64b26c91ec https://doi.org/10.1161/hc3901.096668

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Volume-Outcome Relation for Physicians and Hospitals Performing Angioplasty for Acute Myocardial Infarction in New York State

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Volume-Outcome Relation for Physicians and Hospitals Performing Angioplasty for Acute Myocardial Infarction in New York State

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider