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 Krankenhausarzte (ALKK)

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Item Type:	Article
Title:	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 Krankenhausarzte (ALKK)
Creators Name:	Zahn, R., Gottwik, M., Hochadel, M., Zeymer, U., Vogt, A., Meinertz, T., Dietz, R., Hauptmann, K.E., Grube, E., Kerber, S., Sechtem, U. and Senges, J.
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 Krankenhausaerzte. 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
Source:	Heart
ISSN:	1355-6037
Publisher:	BMJ Publishing Group
Volume:	94
Number:	3
Page Range:	329-335
Date:	March 2008
Official Publication:	https://doi.org/10.1136/hrt.2007.118737
PubMed:	View item in PubMed

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