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The association between institutional primary angioplasty procedure volume and outcome in elderly Americans
N R Every1, C Maynard, K Schulman
1VA Puget Sound Healthcare System, 1660 South Columbian Way, HSR&D (152), Seattle, WA, 98108, USA. nevery@u.washington.edu
Insights
Higher volume hospitals performing primary angioplasty are associated with better patient outcomes. Patients treated at hospitals with more primary percutaneous transluminal coronary angioplasty (PTCA) procedures experienced lower mortality rates.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
Background:
- Established link between high procedure volume and improved outcomes in cardiac interventions like bypass surgery.
- The relationship between primary angioplasty volume and patient outcomes remained unexamined.
Purpose of the Study:
- To investigate the association between primary angioplasty procedural volume and patient outcomes.
- To determine if hospital volume impacts short- and long-term mortality in acute myocardial infarction patients treated with primary angioplasty.
Main Methods:
- Analysis of 6,124 acute myocardial infarction patients undergoing primary coronary angioplasty.
- Patients selected from the Cooperative Cardiovascular Project database, excluding those in shock.
- Hospitals were categorized into quartiles based on their primary PTCA procedure volume.
Main Results:
- Most U.S. hospitals performed fewer than three primary PTCA procedures monthly.
- Hospitals in the lowest volume quartile had a 31% higher 30-day mortality rate compared to the highest volume quartile.
- Higher primary PTCA hospital volume was independently associated with reduced 30-day mortality (OR per quartile = 0.91).
Conclusions:
- A significant proportion of U.S. hospitals (82%) perform low volumes of primary PTCA (<3/month).
- Higher hospital volume for primary PTCA was linked to decreased short- and long-term mortality in elderly patients.
- This volume-outcome association persisted regardless of overall PTCA volume.
Background:
The association between greater procedure volume and improved patient outcome in cardiac procedures has been established in percutaneous transluminal coronary angioplasty (PTCA), coronary stent placement and coronary bypass surgery. The association between primary angioplasty volume and outcome has not been evaluated.
Methods:
We evaluated the association between the volume of primary angioplasty procedures with short- and long-term outcome in 6,124 patients with documented acute myocardial infarction. Patients without shock on presentation treated with primary coronary angioplasty within 12 hours of hospital admission were selected from consecutive infarct patients included in the Cooperative Cardiovascular Project database. Patients were divided into quartiles based on the volume of primary PTCA procedures performed at their admitting hospital.
Results:
The majority of United States (US) hospitals performed less than three primary PTCA procedures per month. Patients admitted to hospitals in the lowest volume quartile of primary PTCA had 31% higher 30-day mortality than those admitted to the highest volume quartile. After adjustment for baseline differences in patient characteristics, there was an association between admission to higher volume primary PTCA hospitals and lower 30-day mortality (odds ratio per volume quartile = 0.91; 95% confidence interval = 0.83-0.99).
Conclusion:
Eighty-two percent of US hospitals perform less than three primary PTCA procedures per month. In elderly Americans treated with primary PTCA, we observed an association between admission to higher volume hospitals and lower short- and long-term mortality. This association was independent of total PTCA volumes.