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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)
  1. Ralf Zahn (erzahn{at}aol.com)
  1. Klinikum Nürnberg, Germany
    1. Martin Gottwik
    1. Klinikum Nürnberg, Germany
      1. Matthias Hochadel
      1. Herzzentrum Ludwigshafen, Germany
        1. Uwe Zeymer
        1. Herzzentrum Ludwigshafen, Germany
          1. Albrecht Vogt
          1. Burgfeld Krankenhaus Kassel, Germany
            1. Thomas Meinertz
            1. Universitätsklinikum Hamburg, Germany
              1. Rainer Dietz
              1. Charite Universitätsklinikum Berlin, Germany
                1. Karl E Hauptmann
                1. Krankenhaus der Barmherzigen Brüder Trier, Germany
                  1. Eberhardt Grube
                  1. Klinikum Siegburg, Germany
                    1. Sebastian Kerber
                    1. Klinikum Bad Neustadt/Saale, Germany
                      1. Udo Sechtem
                      1. Robert Bosch Krankenhaus Stuttgart, Germany
                        1. Jochen Senges
                        1. Herzzentrum Ludwigshafen, Germany

                          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.

                          • coronary angioplasty
                          • risk
                          • volume-outcome relation

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