Association of hospital primary angioplasty volume in ST-segment elevation myocardial infarction with quality and...

Area of Science:

• Cardiology
• Health Services Research

Background:

• Previous research suggests a link between lower hospital volume and increased mortality for ST-segment elevation myocardial infarction (STEMI) primary angioplasty.
• Contemporary data on this relationship are limited.

Purpose of the Study:

• To investigate the association between hospital primary angioplasty volume and patient outcomes.
• To evaluate the relationship between hospital volume and quality of care measures in STEMI patients undergoing primary angioplasty.

Main Methods:

• Observational analysis of 29,513 STEMI patients undergoing primary angioplasty.
• Data sourced from the American Heart Association's Get With the Guidelines registry (2001-2007).
• Hospitals categorized into tertiles based on annual primary angioplasty volume: low (<36), medium (36-70), and high (>70 procedures/year).

Main Results:

• High-volume centers demonstrated shorter median door-to-balloon (DTB) times (88 minutes) compared to medium (90) and low (98) volume centers.
• High-volume centers showed greater adherence to evidence-based guidelines at discharge.
• No significant differences were observed in crude or adjusted in-hospital mortality or length of hospital stay across volume groups.

Conclusions:

• Higher-volume primary angioplasty centers for STEMI are associated with improved process measures, including shorter DTB times and increased use of evidence-based therapies.
• Hospital primary angioplasty volume was not significantly associated with adjusted in-hospital mortality or length of stay in this contemporary cohort.