Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)
- R Zahn1,
- M Gottwik2,
- M Hochadel2,
- J Senges2,3,
- U Zeymer3,
- A Vogt4,
- T Meinertz5,
- R Dietz6,
- K E Hauptmann7,
- E Grube8,
- S Kerber9,
- U Sechtem10
- 1Klinikum Nürnberg Süd, Nürnberg
- 2Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen
- 3Herzzentrum, Kardiologie, Ludwigshafen
- 4Burgfeld Krankenhaus, Kassel
- 5Universitätskrankenhaus Eppendorf, Hamburg
- 6Charité Universitätsmedizin, Berlin
- 7Krankenhaus der Barmherzigen Brüder, Trier
- 8Klinikum Siegburg GmbH, Siegburg
- 9Klinikum, Bad Neustadt/Saale
- 10Robert Bosch Krankenhaus, Stuttgart
- Priv.-Doz. Dr. med. Ralf Zahn, Med. Klinik 8, Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg, Breslauer Straße 201, 90471 Nürnberg;
- Accepted 19 June 2007
- Published Online First 30 July 2007
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 27 965 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). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 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.
Competing interests: None declared.