Clinical outcomes in a community-based single operator coronary interventional program

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Low-volume centers (<200 procedures/year) and physicians (<75 procedures/year) performing coronary interventions are associated with increased procedural risk and poorer outcomes.
• This perception often leads to patient reluctance to undergo procedures at such facilities.

Purpose of the Study:

• To evaluate the clinical outcomes of coronary interventions performed in a low-volume community hospital setting.
• To determine if a low-volume program can achieve results comparable to high-volume referral centers.

Main Methods:

• Retrospective analysis of 559 patients undergoing multi-device coronary interventions between 1994 and 2002.
• Procedures performed by a single operator in a community hospital with on-site cardiac surgical services.
• Analysis included patients with ST-elevation myocardial infarction and acute cardiogenic shock.

Main Results:

• Mortality was <1% when patients with ST-elevation myocardial infarction and cardiogenic shock were excluded.
• The 6-month target lesion revascularization rate was 9.1% overall and 7.8% for coronary stents.
• From 1999-2002, these rates decreased to 2.1% and 1.9%, respectively, indicating improved outcomes over time.

Conclusions:

• A low-volume coronary interventional program can achieve success rates and patient outcomes comparable to high-volume centers.
• These findings hold true even when including high-risk patients with ST-elevation myocardial infarction.
• This suggests that operator experience and dedicated care can mitigate risks associated with lower procedural volumes.