Effects of Cardiologist Experience on Outcomes of Patients With ST-Elevated Myocardial Infarction Treated With Primary PCI in a Local Area in Japan

Abstract

SummaryPrimary percutaneous coronary intervention (PCI) for ST-elevated myocardial infarction (STEMI) results in dramatically improved clinical outcomes when performed in a timely manner. Although guidelines for STEMI patients recommend PCI should be performed by experienced operators with acceptable PCI volume, cardiologists in a local area must perform primary PCI at their own hospitals. This study evaluated the effects of cardiologist experience on outcomes for STEMI patients in a local area in Japan.Between April 2007 and March 2010, 140 consecutive STEMI patients were admitted to our hospital and 121 of these patients received primary PCI. STEMI patients undergoing primary PCI were divided into two groups according to the operator's experience as a cardiologist. We retrospectively analyzed their clinical backgrounds, PCI findings, in-hospital outcomes, and drug administration at discharge.There were no significant differences in any clinical characteristics, angiographic findings, or PCI procedures between the two groups. Clinical outcomes of the two groups were similar, except for the length of hospital stay (21.1 ± 5.8 versus 15.5 ± 9.7; P = 0.0255). The frequency of administration of drugs such as β-blockers (59.1% versus 34.0%; P = 0.0086), aldosterone blockade (10.4% versus 25.5%; P = 0.0334), and nicorandil (76.1% versus 25.5%; P = < 0.0001) was different between the two groups.The clinical outcomes of STEMI patients in this study were satisfactory and almost equivalent when compared according to the experience of the attending cardiologist. The present findings suggest the important clinical implication that younger cardiologists who have experienced PCI procedures to a certain extent can safely perform primary PCI and contribute to better prognoses of STEMI patients. (Int Heart J 2011; 52: 127-130)

Differences of in-hospital outcomes within patients undergoing percutaneous coronary intervention at institutions with high versus low procedural volume: a report from the Japanese multicentre percutaneous coronary intervention registry

“…As a rather large proportion of PCI centres in Japan still perform less than 200 PCIs annually,22 23 it is of critical importance to determine if and to what extent institutional volume is associated with clinical outcome. Therefore, the objective of our investigation was to (1) compare clinical characteristics, treatment patterns and adherence to guidelines on medication between low-volume and high-volume PCI centres and (2) evaluate the association between institutional volume and in-hospital adverse outcomes using the Japan Cardiovascular Database–Keio inter-hospital Cardiovascular Studies (JCD-KiCS) PCI registry.…”

Effects of Nicorandil on All-Cause Mortality and Cardiac Events in CAD Patients Receiving PCI

“…1,2) Percutaneous coronary intervention (PCI) is an efficient method widely used in coronary artery disease (CAD) for relieving myocardial ischemia and preserving ventricular function. 3,4) However, PCI in CAD patients can cause coronary microvascular dysfunction which leads to myocardial damage and a poor long-term prognosis. [5][6][7] PCI can also lead to abnormal microvascular vasomotility and distal coronary microembolization of atheromatous and thrombotic debris and may cause aggravation of microcirculatory disturbance, abnormal myocardial metabolism, and myocardial necrosis.…”