Effects of Hospital Volume of Primary Percutaneous Coronary Interventions on Angiographic Results and In-Hospital Outcomes for Acute Myocardial Infarction

Abstract

rimary percutaneous coronary intervention (PCI) is now established as a first-line therapeutic strategy for patients with acute myocardial infarction (AMI). Several reports from the US and France regarding patients undergoing primary PCI have demonstrated an inverse relationship between the hospital volume of primary PCI and in-hospital mortality. [1][2][3][4] According to the guidelines for PCI published by the American Heart Association (AHA), the American College of Cardiology (ACC), and the Circulation Journal Vol.72, July 2008Society for Cardiovascular Angiography and Interventions (SCAI) in 2005, primary PCI for ST-segment elevation AMI should be performed in centers with an annual volume of at least 400 elective and 36 primary PCI procedures. 5 In contrast, another recent report from Tsuchihashi et al demonstrated that low-volume hospitals and high-volume hospitals had similar in-hospital outcomes for primary PCI. 6 However, detailed data on the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis are still lacking in Japan. It is also uncertain whether the AHA/ACC/SCAI guidelines for primary PCI are appropriate in Japan. The AMI-Kyoto Multi-Center Risk Study, a large multicenter observational study in which 16 collaborating hospitals in Kyoto Prefecture collected demographic, procedural, and outcome data on AMI patients, was established in 2000 in order to analyze such data and establish an emergency-hospital network for heart diseases in Kyoto. [7][8][9] The purpose of the present study was to compare angiographic results and in-hospital outcomes in AMI patients undergoing primary PCI at low-volume hospitals with those at high-volume hospitals, using data from the AMI-Kyoto Multi-Center Risk Study. Background Several clinical studies have demonstrated an inverse relationship between hospital volume of primary percutaneous coronary interventions (PCI) and in-hospital mortality. However, the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis in patients with acute myocardial infarction (AMI) have not been fully investigated in Japan. Methods and ResultsUsing the AMI-Kyoto Multi-Center Risk Study database between January 2000 and December 2005, hospitals were classified into quintiles based on their annual volume of primary PCI. The fifth quintile of hospitals was labeled as high-volume, and the other quintiles were combined and defined as lowvolume. Although patients undergoing primary PCI in high-volume hospitals (high-volume group, n=764) had a larger number of diseased vessels at initial coronary angiography and lower Thrombolysis In Myocardial Infarction (TIMI) flow grade in the infarct-related artery before PCI, compared with those in low-volume hospitals (low-volume group, n=1,021), the rates of achieving TIMI flow grade 3 just after PCI in the high-volume group was significantly higher than that in the low-volume group. The overall in-hospital mortality did not differ between the 2 groups. On multivariate anal...

ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures

“…Online Appendix 3 summarizes 16 published studies examining the relationship between operator and institutional volume and outcomes in patients undergoing PPCI. Of those studies, 4 showed no relationship between volume and mortality, [88][89][90][91] although the latter (the only US study of all 4 reports) demonstrated shorter door-to-balloon (DTB) time and greater adherence to evidence-based therapies observed in higher-volume PPCI centers. 91 Of the 12 remaining reports, 10 studies 58,[92][93][94][95][96][97][98][99][100] demonstrated a significant inverse relationship between hospital PPCI volume and in-hospital mortality, whereas 2 studies 101,102 showed similar relationships relating hospital total PCI volume to mortality.…”

Total Center Percutaneous Coronary Intervention Volume and 30-Day Mortality

“…For the overall PCI cohort, the evidence for a trend The findings are consistent with earlier studies that have found no evidence of a relationship between PCI volume and risk-adjusted mortality outcomes. [16][17][18]26,27 Although many other existing studies have argued in favor of higher-volume centers, the importance of adjustment for case selection and hospital effects cannot be understated. One of the largest studies to date 15 found that although crude mortality estimates increased exponentially at lower volume institutions, there was no relationship between hospital volume and mortality after consideration of confounding factors.…”

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

“…8,9) However, several reports from Japan showed there was no significant relationship between hospital volume and in-hospital outcome among AMI patients undergoing PCI. 10,11) Since not all STEMI patients can always present at highvolume centers that comply with the guideline, cardiologists belonging to PCI centers in a local area must perform primary PCI for STEMI patients in as timely a manner as possible even if their PCI volume does not meet with the guideline criteria. The number of doctors in local areas in Japan has been decreasing every year, and this is now a very serious problem in Japan.…”