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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Published on: March 15, 2022

The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis

Piet N Post1, Michiel Kuijpers, Tjark Ebels

  • 1Dutch Institute for Healthcare Improvement CBO, PO Box 20064, 3502 LB Utrecht, The Netherlands.

European Heart Journal
|June 1, 2010
PubMed

Insights

High-volume hospitals performing coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) show lower in-hospital mortality. This positive relationship between procedure volume and patient outcomes remains consistent in current medical practice.

Area of Science:

  • Cardiology
  • Health Services Research
  • Surgical Outcomes

Background:

  • Studies suggest higher procedure volumes correlate with better outcomes for coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI).
  • The strength and current relevance of this volume-outcome relationship require further investigation.

Purpose of the Study:

  • To quantify the association between hospital procedure volume and in-hospital mortality for CABG and PCI.
  • To determine if this relationship has changed over time in contemporary practice.

Main Methods:

  • A systematic literature search was conducted across Medline, Embase, and conference reports.
  • Meta-analysis included 10 studies for PCI (1,322,342 patients) and 7 studies for CABG (1,470,990 patients).
  • Outcomes were adjusted for case-mix differences; meta-regression explored temporal trends.

Main Results:

  • High-volume hospitals were associated with significantly lower in-hospital mortality for both PCI (OR 0.87, 95% CI 0.83-0.91) and CABG (OR 0.85, 95% CI 0.79-0.92).
  • No specific volume thresholds demonstrated a differential effect.
  • Meta-regression indicated no significant attenuation of the effect size over time.

Conclusions:

  • Patients undergoing CABG or PCI at high-volume hospitals experience reduced in-hospital mortality.
  • The volume-outcome relationship for these procedures remains robust and has not diminished in recent years.
Abstract

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