Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery

Abstract

Background: Percutaneous coronary intervention (PCI) is performed in a wide range of institutions. We sought to assess the relationship between coronary artery bypass grafting (CABG) volume relative to PCI volume and clinical outcome using nationally representative PCI and CABG registries in Japan. Methods: This was a collaborative, registry-based cohort study enrolling patients undergoing percutaneous coronary intervention in 2013–2014 using Japanese nationwide registry (J-PCI) with follow up until discharge. The absolute volume of CABG for each hospital was calculated using additional data from Japan CardioVascular Surgery Database (JCVSD). Patients undergoing their first PCI registered in the registry (N = 220,934), at 943 facilities were studied. Main outcomes were in-hospital mortality, and incidence of composite of in-hospital death and postprocedural complications. Results: Among the 220,934 patients, 162,411 were men, with a mean age of 69.7 (SD 11.6) years. Patients underwent PCI at hospitals with varying CABG volume: The overall in-hospital mortality and composite event rate for PCI patients was 0.9% and 2.4%, respectively. CABG volume was associated with the in-hospital mortality of PCI at facilities performing less than 200 PCIs per year, but not at facilities performing 200 or more. Similarly, in-hospital mortality or complication was associated with PCI volume <200 only if no CABG is done at the facility. The result remained largely consistent in subgroup of patients presenting with acute coronary syndrome or even after excluding these institutions with extremely low number of PCI (<50 cases/year) or CABG (<15 cases / year). Conclusions: In a nationwide registry-based analysis, the surgical volume was associated with patients’ clinical outcome after PCI, when limited number of PCIs were performed at the facility.

Impact of extracardiac vascular disease on outcomes of 1.4 million patients undergoing percutaneous coronary intervention

“…Fourth, the NIS doesn't capture pre-hospital medical treatments, chronic for in this analysis. [33][34][35][36][37] Finally, the design of this study does not allow the measurement of any causal relationship, but only association between ECVD and in-hospital outcomes.…”

“…Sixth, other predictors of PCI outcome such as the timing to PCI, volume of PCI in the centre/operator, vascular access, anatomy and extent of coronary disease, PCI complications, the completeness of revascularisation, and the use of coronary physiology and other procedures were not accounted for in this analysis. 33 , 34 , 35 , 36 , 37 Finally, the design of this study does not allow the measurement of any causal relationship, but only association between ECVD and in‐hospital outcomes.…”

Association of the Hemoglobin to Serum Creatinine Ratio with In-Hospital Adverse Outcomes after Percutaneous Coronary Intervention among Non-Dialysis Patients: Insights from a Japanese Nationwide Registry (J-PCI Registry)

“…For the present analysis, we extracted the patient-based data from the ongoing J-PCI registry. The overview of this Japanese nationwide PCI registry has been previously reported in detail [ 14 , 22 , 23 , 24 , 25 , 26 , 27 ]. Briefly, the J-PCI registry is a prospective, multicenter registry of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), that aims to collect the characteristics and clinical outcomes of patients undergoing PCI.…”

To the Future and Beyond: Recent Advances in the Application of Percutaneous Coronary Intervention

“…However, the impact of PCI volume in relation to absolute surgical volume has not been studied extensively. In a nationwide registry-based analysis involving 220,934 patients, surgical CABG volume was associated with patients’ clinical outcomes after PCI when a limited number of PCIs were performed at the facility (e.g., less than 200/year) [ 13 ]. The findings suggest that seeking an ideal balance between surgical and interventional revascularization procedures may result in improved outcomes.…”