Volume-Outcome Relationships for Percutaneous Coronary Interventions in the Stent Era

Hannan, Edward L.; Wu, Chuntao; Walford, Gary; King, Spencer B.; Holmes, David R.; Ambrose, John A.; Sharma, Sanjeev; Katz, Stanley; Clark, Luther T.; Jones, Robert H.

doi:10.1161/circulationaha.104.528455

Cited by 173 publications

(159 citation statements)

References 22 publications

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“…Based on the intuitive concept that ''practice makes perfect'' and supported by the demonstration of such relations with surgical procedures, the linkage of operator and institutional volume to PCI quality has been assumed [25][26][27][28][29][30][31][32][33].…”

Section: Public Reporting Of Pci Volumementioning

confidence: 99%

Quality assessment and improvement in interventional cardiology: A position statement of the society of cardiovascular angiography and interventions, Part II: Public reporting and risk adjustment

Klein

Singh

et al. 2011

Cathet Cardio Intervent

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Section: Public Reporting Of Pci Volumementioning

confidence: 99%

Quality assessment and improvement in interventional cardiology: A position statement of the society of cardiovascular angiography and interventions, Part II: Public reporting and risk adjustment

Klein

Singh

et al. 2011

Cathet Cardio Intervent

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“…This relationship has been confirmed during both the pre-and post-stent eras (4). The ESPRIT dataset suggests that procedural outcome after PCI is a function of institutional volume, but not operator volume.…”

Section: Discussionmentioning

confidence: 76%

“…Many US-based studies have reported a strong inverse relationship between annual PCI volumes performed by an individual physician or institution and clinical outcomes after PCI (1)(2)(3)(4)(5)(6). This relationship has been confirmed during both the pre-and post-stent eras (4).…”

Section: Discussionmentioning

confidence: 89%

“…A n inverse relationship between the annual number of patients treated by a hospital or physician and rates of ischemic complications after percutaneous coronary intervention (PCI) has been well established by previous publications (1)(2)(3)(4)(5)(6). Although the interpretation of this literature with regard to policy making is controversial, such data have been used to establish the current American College of Cardiology recommendations for a minimum operator volume of 75 cases per year and a minimum institutional volume of 200 procedures per year (ideally 400 or more PCIs per year) to maintain both operator and institutional competence (7).…”

Section: Méthodologie Et Résultatsmentioning

confidence: 95%

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Effect of operator and institutional volume on clinical outcomes after percutaneous coronary interventions performed in Canada and the United States: A brief report from the Enhanced Suppression of the Platelet glycoprotein IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) study

Madan

Nikhil

Hellkamp

et al. 2009

Canadian Journal of Cardiology

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BACKGROUND:The Enhanced Suppression of the Platelet glycoprotein IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial compared the use of eptifibatide with placebo in 2064 coronary intervention patients. It was previously reported that Canadian patients had reduced rates of 30-day and one-year death, myocardial infarction (MI) or targetvessel revascularization (TVR) compared with patients in the United States (US). OBJECTIVE: To examine whether operator or institutional volume differences explain the regional variation in clinical outcome. METHODS AND RESULTS:Each site received an operator and institutional volume survey. Fifty-seven sites (62%) returned complete data on 1338 patients. In this smaller cohort, Canadian patients had reduced rates of 30-day and one-year death, MI or TVR compared with US patients (6.3% versus 10.3% and 14.9% versus 20.1%, respectively; P<0.05 for both comparisons). Among 176 physicians with a median of 13 years experience, the median operator volume was 200 cases per year. Operators with fewer than 100 cases per year had higher rates of 30-day death, MI or TVR (13.2% versus 8.7%; P=0.18) and large MI (7.7% versus 3.3%; P=0.06) than those with 100 or more cases per year. The median institutional volume was 1064 cases per year. Canadian and US centres had similar operator and institutional volumes. By multivariate modelling, operator volume was not predictive of adverse clinical events. However, the rates of 30-day and one-year death, MI or TVR fell by 3% for every 100 patients treated by the institution (OR 0.97; P=0.058 and P=0.002, respectively). Enrollment in Canada was associated with improved outcomes at 30 days (OR 0.50; P=0.001) and one year (OR 0.66; P=0.001) despite inclusion of volume variables in the models. CONCLUSIONS: In the ESPRIT study, institutional volume was associated with a modest reduction in risk of death, MI or TVR over short-and long-term follow-up periods. The Canadian and US investigators and institutions selected in ESPRIT had similar annual procedural volumes. Therefore, volume variables did not explain the differential risk of clinical events observed for patients enrolled in the two countries. MÉTHODOLOGIE ET RÉSULTATS :Chaque établissement a reçu un sondage sur le volume de l'opérateur et de l'établissement. Cinquante-sept établissements (62 %) ont retourné des données complètes sur 1 338 patients. Dans cette cohorte plus petite, les patients canadiens présentaient un taux réduit de décès au bout de 30 jours et d'un an, d'IM ou de RVC par rapport aux patients des États-Unis (6,3 % par rapport à 10,3 % et 14,9 % par rapport à 20,1 %, respectivement; P<0,05 dans les deux comparaisons). Chez les 176 médecins ayant une expérience médiane de 13 ans, le volume médian de l'opérateur était de 200 cas par année. Les opérateurs voyant moins de 100 cas par année présentaient un taux plus élevé de décès au bout de 30 jours, d'IM ou de RVC (13,2 % par rapport à 8,7 %; P=0,18) et de gros IM (7,7 % par rapport à 3,3 %; P=0,06) que ceux en voyant au moins 100 par...

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“…Even in the stent era, an inverse relationship between hospital PCI volume and in-hospital outcome has been reported to be preserved, especially for emergency procedures. 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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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)

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Volume-Outcome Relationships for Percutaneous Coronary Interventions in the Stent Era

Abstract: Higher-volume operators and hospitals continue to experience lower risk-adjusted PCI outcome rates.

Cited by 173 publications

References 22 publications

Quality assessment and improvement in interventional cardiology: A position statement of the society of cardiovascular angiography and interventions, Part II: Public reporting and risk adjustment

Quality assessment and improvement in interventional cardiology: A position statement of the society of cardiovascular angiography and interventions, Part II: Public reporting and risk adjustment

Effect of operator and institutional volume on clinical outcomes after percutaneous coronary interventions performed in Canada and the United States: A brief report from the Enhanced Suppression of the Platelet glycoprotein IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) study

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

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