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The volume-outcome relationship of percutaneous coronary intervention: can current procedure volume minimums be

Herng-Ching Lin1, Hsin-Chien Lee, Chien-Heng Chu

  • 1School of Health Care Administration, Taipei Medical University, Taipei, Taiwan. henry11111@tmu.edu.tw

American Heart Journal
|February 26, 2008
PubMed

Insights

In Taiwan, low-volume percutaneous coronary intervention (PCI) hospitals showed higher 30-day mortality. However, medium-volume PCI hospitals did not significantly differ from high-volume ones, suggesting guideline reevaluation.

Area of Science:

  • Cardiology
  • Health Services Research
  • Public Health

Background:

  • The American College of Cardiology/American Heart Association (ACC/AHA) recommends a minimum annual hospital volume of 400 percutaneous coronary intervention (PCI) cases.
  • The applicability of this guideline in non-Western developing countries like Taiwan remains uncertain.

Purpose of the Study:

  • To evaluate the adherence and impact of the ACC/AHA minimum hospital PCI volume guidelines in Taiwan.
  • To assess the association between hospital PCI volume and 30-day mortality in the Taiwanese population.

Main Methods:

  • Analysis of the 2003 Taiwan National Health Insurance Research Database and Cause of Death Data File.
  • Comparison of 30-day mortality risk for 12,369 patients treated at low (<200), medium (200-399), and high (≥400) PCI volume hospitals.
  • Multivariable logistic regression using generalized estimating equations to adjust for confounding factors.

Main Results:

  • Crude 30-day mortality rates were 3.10% (low), 2.82% (medium), and 1.80% (high) volume hospitals.
  • Patients at low-PCI volume hospitals had significantly higher odds of 30-day mortality (OR 1.54) compared to high-volume hospitals.
  • The adjusted odds of 30-day mortality for medium-volume hospitals were not statistically different from high-volume hospitals (OR 1.33).

Conclusions:

  • The current ACC/AHA minimum PCI hospital volume standard may require reevaluation for non-Western developing countries.
  • While high-volume PCI centers demonstrated the lowest mortality, medium-volume centers performed comparably to high-volume centers in Taiwan.
  • Findings suggest that the threshold for optimal PCI care may differ in diverse healthcare systems.
Abstract

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