Impact of Institutional and Operator Volume on Short-Term Outcomes of Percutaneous Coronary Intervention

Inohara, Taku; Kohsaka, Shun; Yamaji, Kyohei; Amano, Tetsuya; Fujii, Kenshi; Oda, Hirotaka; Uemura, Shiro; Kadota, Kazushige; Matsubara, Hiroaki; Nakamura, Masato; Shiode, Nobuo; Tanaka, Nobuhiro; Akasaka, Takashi; Morino, Yoshihiro; Hikichi, Hiroshi; Ishii, Hideki; Tanabe, Kengo; Ozaki, Yukio; Sumitsuji, Satoru; Iida, Osamu; Hara, Hidehiko; Takashima, Hiroaki; Shirai, Shinichi; Nansato, Mamoru; Ueda, Yasunori; Numasawa, Yohei; Noma, Shigetaka

doi:10.1016/j.jcin.2017.02.015

Cited by 67 publications

(37 citation statements)

References 29 publications

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“…In terms of data derived from Japanese population, there are several registries including patients with AMI in Japan such as J-MINUET [ 24 , 25 ], PACIFIC [ 26 ], and Tokyo CCU network registry [ 27 ]. CVIT has been working on J-PCI registry [ 28 – 31 ], a largest database of patients who underwent PCI in Japan. The current demographics, lesion and procedural characteristics in patients with AMI in Japan can be identified in the J-PCI registry (Tables 3 , 4 ) [from a database including 243436 patients treated in 986 institutions from January 2016 to December 2016].…”

Section: Introductionmentioning

confidence: 99%

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018

Ozaki

Katagiri

Onuma

et al. 2018

Cardiovasc Interv and Ther

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While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.

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Section: Introductionmentioning

confidence: 99%

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018

Ozaki

Katagiri

Onuma

et al. 2018

Cardiovasc Interv and Ther

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“… 7) Furthermore, new technologies like IVUS and FFR have been introduced, and PCI operators now have many opportunities to learn about PCI techniques at domestic and international live demonstration meetings and conferences. 19) 20) 21) …”

Section: Discussionmentioning

confidence: 99%

“… 24) 25) A recent Japanese PCI (J-PCI) registry report showed the probability of mortality plateaued at approximately 100 procedures per year. 21) Korean Society of Interventional Cardiology (KSIC) certified hospitals are required to carry out at least 100 PCI cases each year, and thus, the study subjects were divided and compared using a cut-off of 100 PCI cases per year. Therefore, the occurrence of MACCE, death, and non-fatal MI was statistically higher in hospitals with less than 100 PCI cases per year ( Supplementary Figure 1 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry

et al. 2020

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Background and Objectives The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. Methods We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. Results Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. Conclusions Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.

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“…However, the actual CV used during PCI procedures differs among currently practicing physicians [ 28 ]. This study, in addition to improving the ability of physicians to recognize patients with higher CI-AKI risks, provides physicians with feedback regarding the value of this index from a large-scale, national registry data investigation [ 20 , 28 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Between 2013 and 2016, we limited data registration to the 4 high-volume centers (N = 5749 among 12,579 cases), with an average case volume of 479. These numbers are not dissimilar from the median PCI cases/year across all the hospitals in Japan (median, 216; interquartile range [IQR], 121–332) [ 20 ].…”

Section: Methodsmentioning

confidence: 96%

Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention

et al. 2018

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BackgroundLimiting the contrast volume to creatinine clearance (V/CrCl) ratio is crucial for preventing contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, the incidence of CI-AKI and the distribution of V/CrCl ratios may vary according to patient body habitus.ObjectiveWe aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs).MethodsWe evaluated 8782 consecutive patients undergoing PCI and who were registered in a large Japanese database. CI-AKI was defined as an absolute serum creatinine increase of 0.3 mg/dL or a relative increase of 50%. The effect of the V/CrCl ratio relative to CI-AKI incidence was evaluated within the low- (≤25 kg/m2) and high- (>25 kg/m2) BMI groups, with a V/CrCl ratio > 3 considered to be a risk factor for CI-AKI.ResultsA V/CrCl ratio > 3 was predictive of CI-AKI, regardless of BMI (low-BMI group: odds ratio [OR], 1.77 [1.42–2.21]; P < 0.001; high-BMI group: OR, 1.67 [1.22–2.29]; P = 0.001). The relationship between BMI and CI-AKI followed a reverse J-curve relationship, although baseline renal dysfunction (creatinine clearance <60 mL/min, 46.9% vs. 21.5%) and V/CrCl ratio > 3 (37.3% vs. 20.4%) were predominant in the low-BMI group. Indeed, low BMI was a significant predictor of a V/CrCl ratio > 3 (OR per unit decrease in BMI, 1.08 [1.05–1.10]; P < 0.001).ConclusionsA V/CrCl ratio > 3 was strongly associated with the occurrence of CI-AKI. Importantly, we also identified a tendency for physicians to use higher V/CrCl ratios in lean patients. Thus, recognizing this trend may provide a therapeutic target for reducing the incidence of CI-AKI.

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Impact of Institutional and Operator Volume on Short-Term Outcomes of Percutaneous Coronary Intervention

Abstract: In contemporary Japanese PCI practice, lower institutional volume was related inversely to in-hospital outcomes, but the association of annual operator volume with outcomes was less clear.

Cited by 67 publications

References 29 publications

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018

Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry

Effects of body habitus on contrast-induced acute kidney injury after percutaneous coronary intervention

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