January 1, 2020Open Access

Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Myocardial Infarction (AMI) (n=17121). Intervention: High hospital PCI volume (≥400/year) vs. Low hospital PCI volume (<400/year). Primary outcome: Major adverse cardiovascular and cerebrovascular events (MACCE) during index admission (p=0.001).

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.

Study Design

Type

Cohort (n=17,121)

Multicenter

Yes

PICO

Population

Acute Myocardial Infarction (AMI) (n=17,121)

Intervention / Comparator

High hospital PCI volume (≥400/year) vs Low hospital PCI volume (<400/year)

Primary Outcome

Major adverse cardiovascular and cerebrovascular events (MACCE) during index admission, p=0.001

Main Result

Absolute Event Rate: 8.6% vs 10.9%

p-value: p=0.001

Limitations

Only included the 92 hospitals that participated in the 2014 K-PCI registry study
Retrospective registry data raises the possibility of input bias
Could not account for the experience of operators or analyze outcomes according to annual operator volume
Only evaluated in-hospital outcomes, lacking long-term follow-up data
Could not compare outcomes based on the presence or absence of cardiac intensive care teams and facilities

Abstract

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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