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Variation in utilization of multivessel percutaneous coronary intervention: influence of hospital volume

Nilay Patel1, Sadip Pant, Sidakpal S Panaich

  • 1aDepartment of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey bDivision of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky cDivision of Cardiovascular Diseases, Detroit Medical Center, Detroit, Michigan dCardiology Division, University of Miami Miller School of Medicine, Miami, Florida eDepartment of Internal Medicine, Mount Sinai St Luke's Roosevelt Hospital fDivision of Cardiology, The Mount Sinai Hospital, New York, New York gInterventional Cardiology, The Everett Clinic, Everett, Washington, USA.

Coronary Artery Disease
|September 5, 2015
PubMed

Insights

Multivessel percutaneous coronary interventions (MVPCI) utilization varies significantly across US hospitals. Higher hospital volume and patient age predict increased MVPCI use, while factors like female sex and urgent admissions predict decreased use.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Services Research

Background:

  • Percutaneous coronary interventions (PCI) are a cornerstone of managing coronary artery disease.
  • Multivessel PCI (MVPCI) involves treating multiple coronary arteries in a single procedure.
  • Understanding trends in MVPCI utilization is crucial for healthcare resource allocation and quality improvement.

Purpose of the Study:

  • To investigate contemporary trends in the utilization of multivessel percutaneous coronary interventions (MVPCI) in the USA.
  • To identify patient and hospital-level factors associated with MVPCI use.
  • To assess the variability in MVPCI utilization across different hospitals.

Main Methods:

  • Utilized the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (2006-2011).
  • Employed International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes to identify MVPCI procedures.
  • Developed a hierarchical three-level model adjusted for confounding factors to analyze utilization predictors.

Main Results:

  • Over 2.6 million procedures were analyzed, with significant variation in MVPCI utilization observed.
  • Older age and higher comorbidity scores (≥2) were associated with increased MVPCI utilization.
  • Female sex, myocardial infarction, weekend/urgent admissions were associated with decreased MVPCI utilization, while higher hospital volume predicted increased use.
  • A substantial between-hospital variation (7.7%) in MVPCI use was noted, minimally influenced by patient or hospital characteristics.

Conclusions:

  • MVPCI utilization rates exhibit considerable variability among US hospitals.
  • Higher annual hospital volume is a significant predictor of increased MVPCI utilization.
  • Patient demographics and clinical factors influence MVPCI use, highlighting the need for standardized treatment protocols.
Abstract

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