Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: Is it limited to high risk patients?<BR> Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Ralf Zahn ^1*, Martin Gottwik ¹, Matthias Hochadel ², Uwe Zeymer ², Albrecht Vogt ³, Thomas Meinertz ⁴, Rainer Dietz ⁵, Karl E Hauptmann ⁶, Eberhardt Grube ⁷, Sebastian Kerber ⁸, Udo Sechtem ⁹ and Jochen Senges ²

¹ Klinikum Nürnberg, Germany
² Herzzentrum Ludwigshafen, Germany
³ Burgfeld Krankenhaus Kassel, Germany
⁴ Universitätsklinikum Hamburg, Germany
⁵ Charite Universitätsklinikum Berlin, Germany
⁶ Krankenhaus der Barmherzigen Brüder Trier, Germany
⁷ Klinikum Siegburg, Germany
⁸ Klinikum Bad Neustadt/Saale, Germany
⁹ Robert Bosch Krankenhaus Stuttgart, Germany

^* To whom correspondence should be addressed. E-mail: erzahn{at}aol.com.

Accepted 19 June 2007

Abstract

Objective The formerly observed volume-outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned.

Design We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte.

Patients In 2003 a total of 27965 patients at 67 hospitals were included.

Results The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). We then compared two groups of patients according to their treatment at hospitals with either <325 PCIs (n=5754) or >325 PCIs (n=22211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95%CI: 0.52-0.87; p=0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004), however there was no association in patients without a myocardial infarction.

Conclusions This analysis of contemporary PCI in clinical practice shows a small but significant volume-outcome relation for in-hospital mortality. However, this relation was only apparent in high risk subgroups, such as patients presenting with acute myocardial infarction.

Keywords: coronary angioplasty, risk, volume-outcome relation

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