Lower Hospital Volume Is Associated With Higher In-Hospital Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction

Kontos, Michael C.; Wang, Yongfei; Chaudhry, Sarwat I.; Vetrovec, George W.; Curtis, Jeptha; Messenger, John C.

doi:10.1161/circoutcomes.113.000233

Cited by 40 publications

(33 citation statements)

References 37 publications

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“…( 12 However, evidence from studies published since the period covered by this meta-analysis have produced a more variable picture, with some studies supporting the presence of a relationship between center PCI volume and risk-adjusted outcomes, 10,11,13,14 and others not. [15][16][17][18] A more recent summary of the evidence by a joint task force from the American College of Cardiology Foundation, American Heart Association, and American College of Physicians acknowledged that the large-scale studies in this area have produced heterogeneous findings.…”

Section: See Editorial By Kumbhani and Bittlmentioning

confidence: 98%

“…[5][6][7][8][9] Such centers often also have high volumes of elective PCI and in much of the published literature compare favorably with lower volume centers where higher rates of adverse outcomes, longer lengths of hospital stay, and increased costs have been observed. 10,11 These findings have been reflected in the reconfiguration of UK PCI services over the past decade, specifically the expectation that lower volume units undertake at least 400 procedures per annum. UK PCI Volume Outcome Relationship UK's quality improvement initiative in PCI and has implications for provision of service in other countries.…”

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confidence: 99%

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Total Center Percutaneous Coronary Intervention Volume and 30-Day Mortality

O’Neill

Nicholas

Gale

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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T he relationship between procedural volume and patient outcomes is an important consideration in the provision of percutaneous coronary intervention (PCI). Studies that have suggested the existence of a relationship have informed international guidelines 1-3 on the minimum procedural limits recommended for annual center volume to ensure safe and effective patient care. This is also reflected in recent UK guidance on the provision of PCI. 4 For acute myocardial infarction, the establishment of high-throughput, high-volume heart attack centers within networks of acute cardiac care has been promoted as a factor contributing to the decline in cardiovascular mortality in developed healthcare systems. [5][6][7][8][9] Such centers often also have high volumes of elective PCI and in much of the published literature compare favorably with lower volume centers where higher rates of adverse outcomes, longer lengths of hospital stay, and increased costs have been observed. 10,11 These findings have been reflected in the reconfiguration of UK PCI services over the past decade, specifically the expectation that lower volume units undertake at least 400 procedures per annum. See Editorial by Kumbhani and BittlIt is timely and of international importance to review the evidence for and against a relationship between PCI center volume and clinical outcomes in the UK healthcare system. Such a national review contributes to the assessment of the Background-The relationship between procedural volume and prognosis after percutaneous coronary intervention (PCI) remains uncertain, with some studies finding in favor of an inverse association and some against. This UK study provides a contemporary reassessment in one of the few countries in the world with a nationally representative PCI registry. Methods and Results-A nationwide cohort study was performed using the national British Cardiovascular Intervention Society registry. All adult patients undergoing PCI in 93 English and Welsh NHS hospitals between 2007 and 2013 were analyzed using hierarchical modeling with adjustment for patient risk. Of 427 467 procedures (22.0% primary PCI) in 93 hospitals, 30-day mortality was 1.9% (4.8% primary PCI). 87.1% of centers undertook between 200 and 2000 procedures annually. Case mix varied with center volume. In centers with 200 to 399 PCI cases per year, a smaller proportion were PCI for ST-segment-elevation myocardial infarction (8.4%) than in centers with 1500 to 1999 PCI cases per year (24.2%), but proportionally more were for ST-segment-elevation myocardial infarction with cardiogenic shock (8.4% versus 4.3%). For the overall PCI cohort, after risk adjustment, there was no significant evidence of worse, or better, outcomes in lower volume centers from our own study, or in combination with results from other studies. For primary PCI, there was also no evidence for increased or decreased mortality in lower volume centers. Conclusions-After adjustment for differences in case mix and clinical presentation, this study supports the conclusion o...

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Section: See Editorial By Kumbhani and Bittlmentioning

confidence: 98%

mentioning

confidence: 99%

Total Center Percutaneous Coronary Intervention Volume and 30-Day Mortality

O’Neill

Nicholas

Gale

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…Primary PCI volume ≤ the guideline-recommended minimum of 36 annually was associated with worse in-hospital mortality in a recent series of over 86,000 patients in the NCDR. 66 The cutoff points of <200 total PCIs annually and ≤36 primary PCIs annually has important implications because 26% of the PCI facilities submitting data to the NCDR performed ≤200 total PCIs annually and 38% performed ≤36 primary PCIs annually. 8,66 Recent data suggested a modest volume-outcome relationship for variables other than mortality, but these data have limitations and are not consistent across all studies.…”

Section: The Volume-outcome Relationship For Pci and The Certificate mentioning

confidence: 99%

“…66 The cutoff points of <200 total PCIs annually and ≤36 primary PCIs annually has important implications because 26% of the PCI facilities submitting data to the NCDR performed ≤200 total PCIs annually and 38% performed ≤36 primary PCIs annually. 8,66 Recent data suggested a modest volume-outcome relationship for variables other than mortality, but these data have limitations and are not consistent across all studies. 4 Although there was an association between annual PCI volumes <200 and worse outcomes, there was no association between higher annual hospital volumes and improved outcomes at higher volume PCI centers.…”

Section: The Volume-outcome Relationship For Pci and The Certificate mentioning

confidence: 99%

SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup

et al. 2014

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“…However, an institutional volume threshold of <200 PCIs annually appeared to be consistently associated with worse outcomes. Primary PCI volume the guideline-recommended minimum of 36 annually was associated with worse in-hospital mortality in a recent series of over 86,000 patients in the NCDR [66]. The cutoff points of <200 total PCIs annually and 36 primary PCIs annually has important implications because 26% of the PCI facilities submitting data to the NCDR performed 200 total PCIs annually and 38% performed 36 primary PCIs annually [8,66].…”

Section: Financial Considerations For Facilities Providing Pci Withoumentioning

confidence: 99%