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Interventional cardiology
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)
  1. R Zahn1,
  2. M Gottwik2,
  3. M Hochadel2,
  4. J Senges2,3,
  5. U Zeymer3,
  6. A Vogt4,
  7. T Meinertz5,
  8. R Dietz6,
  9. K E Hauptmann7,
  10. E Grube8,
  11. S Kerber9,
  12. U Sechtem10
  1. 1
    Klinikum Nürnberg Süd, Nürnberg
  2. 2
    Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen
  3. 3
    Herzzentrum, Kardiologie, Ludwigshafen
  4. 4
    Burgfeld Krankenhaus, Kassel
  5. 5
    Universitätskrankenhaus Eppendorf, Hamburg
  6. 6
    Charité Universitätsmedizin, Berlin
  7. 7
    Krankenhaus der Barmherzigen Brüder, Trier
  8. 8
    Klinikum Siegburg GmbH, Siegburg
  9. 9
    Klinikum, Bad Neustadt/Saale
  10. 10
    Robert Bosch Krankenhaus, Stuttgart
  1. Priv.-Doz. Dr. med. Ralf Zahn, Med. Klinik 8, Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg, Breslauer Straße 201, 90471 Nürnberg; erzahn{at}aol.com

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 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.

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Footnotes

  • Competing interests: None declared.

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