RT Journal Article
SR Electronic
T1 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)
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 329
OP 335
DO 10.1136/hrt.2007.118737
VO 94
IS 3
A1 Zahn, R
A1 Gottwik, M
A1 Hochadel, M
A1 Senges, J
A1 Zeymer, U
A1 Vogt, A
A1 Meinertz, T
A1 Dietz, R
A1 Hauptmann, K E
A1 Grube, E
A1 Kerber, S
A1 Sechtem, U
YR 2008
UL http://heart.bmj.com/content/94/3/329.abstract
AB 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.