Volume–outcomes relationship in the Era of modern coronary intervention—results from the prospective multicenter German DES.DE Registry

Akın, İbrahim; Hochadel, M.; Schneider, Steffen; Abdel‐Wahab, Mohamed; Zahn, Ralf; Senges, Jochen; Richardt, Gert; Kück, Karl‐Heinz; Nienaber, Christoph

doi:10.1002/ccd.24986

Cited by 5 publications

(10 citation statements)

References 35 publications

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“…36 Recognizing that 61% of PCI operators in 2008, accounting for 30% of all PCIs performed nationally, performed ≤40 Medicare fee-for-service PCIs argues for the consolidation rather than addition of cardiac catheterization laboratories and for further regionalization of PCI care. 9 Although other studies have shown an inverse relationship between hospital volume and mortality [37][38] , our study is the first meta-analysis to our knowledge to demonstrate a similar association between operator volume and outcomes.…”

supporting

confidence: 47%

Association Between Operator Procedure Volume and Patient Outcomes in Percutaneous Coronary Intervention

Strom

Wimmer

Wasfy

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background-The growth of centers capable of performing percutaneous coronary intervention (PCI) has outpaced population growth despite declining incidence of myocardial infarction and prevalence of coronary artery disease, potentially increasing the proportion of operators falling below minimal yearly volume standards set by professional societies. Methods and Results-Electronic literature search of MEDLINE and the Cochrane Library for English-language articles published between 1977 and November 2012 was performed. Title and abstract review followed by full-text and references review were performed by 2 authors independently to identify studies examining the association between operator volume and outcomes in PCI. Using a standardized form, 2 authors abstracted information on study design, methods, outcomes, statistical methods, and conclusions. Studies were categorized according to methodological quality and outcomes. Metaanalyses were performed by outcome using a random-effects model. Of the 23 studies included in the analysis, 14 (61%) evaluated mortality, 7 (30%) evaluated major adverse cardiac events, and 2 (9%) evaluated angiographic success. In total, the studies evaluated 15 907 operators performing 205 214 PCIs on 1 109 103 patients at 2456 centers with a mean follow-up of 2.8 years. Eleven (48%) were considered higher quality. Studies with higher methodological quality and large sample sizes more often showed a relationship between operator volume and outcomes in PCI. Higher volume was associated with improved major adverse cardiac events at every threshold, regardless of the threshold evaluated. Conclusions-Mortality and major adverse cardiac events increase as operator volumes decrease in PCI. Among studies showing a relationship, high-volume operators were defined variably, with annual PCIs ranging from >11 to >270, with no clear evidence of a threshold effect within the ranges studied. (Circ Cardiovasc Qual Outcomes. 2014;7:560-566.)

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supporting

confidence: 47%

Association Between Operator Procedure Volume and Patient Outcomes in Percutaneous Coronary Intervention

Strom

Wimmer

Wasfy

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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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.…”

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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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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“…The bleeding and vascular complications occurred infrequently in the present study. This could be ascribed to high‐volume teaching centers participating in the study . The higher bleeding rates in the octogenarians group were observed and are as a result of vascular fragility associated with advanced age, comorbid conditions that can cause increased bleeding rates and more frequent use of oral anticoagulants.…”

Section: Discussionmentioning

confidence: 94%

“…Another point should be considered. The study, albeit a registry, was carried out in high‐volume teaching hospitals by experienced operators, which could influence clinical outcomes …”

Section: Discussionmentioning

confidence: 99%

Favorable outcomes in octogenarians treated with bioresorbable polymer drug‐eluting stent

Ilić

Stanković

Ilisic

et al. 2015

Geriatrics Gerontology Int

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Volume–outcomes relationship in the Era of modern coronary intervention—results from the prospective multicenter German DES.DE Registry

Abstract: In the era of modern coronary intervention technological advances such as DES have not offset the inverse relation between procedural volume and both in-hospital and 1-year outcomes after PCI.

Cited by 5 publications

References 35 publications

Association Between Operator Procedure Volume and Patient Outcomes in Percutaneous Coronary Intervention

Association Between Operator Procedure Volume and Patient Outcomes in Percutaneous Coronary Intervention

Total Center Percutaneous Coronary Intervention Volume and 30-Day Mortality

Favorable outcomes in octogenarians treated with bioresorbable polymer drug‐eluting stent

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