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Relationship Between Operator Volume and Long-Term Outcomes After Percutaneous Coronary Intervention
Alexander C Fanaroff1,2, Pearl Zakroysky2, Daniel Wojdyla2
1Division of Cardiology (A.C.F., M.T.R., T.Y.W., E.D.P., S.V.R.), Duke University, Durham, NC.
Circulation
|December 28, 2018
Summary
Higher operator volume in percutaneous coronary intervention (PCI) is linked to lower in-hospital death rates for older adults. However, long-term outcomes like major adverse coronary events (MACE) showed no significant difference after risk adjustment.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
Background:
- Operator procedural volume is known to impact short-term outcomes after percutaneous coronary intervention (PCI).
- The association between operator PCI volume and longer-term patient outcomes remains largely unknown.
- Understanding this relationship is crucial for optimizing patient care and procedural quality.
Purpose of the Study:
- To investigate the association between operator percutaneous coronary intervention (PCI) volume and long-term outcomes in patients aged 65 years and older.
- To stratify operators based on annual PCI volume and analyze their impact on patient mortality and major adverse coronary events (MACE).
- To determine if higher operator volume correlates with improved or diminished long-term patient health after PCI.
Main Methods:
- Utilized the National Cardiovascular Data Registry CathPCI registry linked with Medicare claims data.
- Stratified 8,936 operators into low (<50), intermediate (50-100), and high (>100) annual PCI volume categories.
- Calculated unadjusted and risk-adjusted 1-year rates of death and MACE (death, myocardial infarction readmission, or unplanned revascularization) using Kaplan-Meier and proportional hazards models.
Main Results:
- A total of 723,644 PCI procedures were analyzed between July 2009 and December 2014.
- Low-volume operators performed more emergency PCIs and treated patients with fewer comorbidities.
- After risk adjustment, intermediate- and high-volume operators showed significantly lower in-hospital mortality compared to low-volume operators, but no significant differences in 1-year post-discharge MACE were observed.
Conclusions:
- Higher operator volume in PCI is associated with reduced in-hospital mortality for older adults.
- No significant differences in major adverse coronary events (MACE) were found between different operator volume groups from hospital discharge to 1-year follow-up.
- Operator procedural volume may influence short-term outcomes more than long-term results for elderly PCI patients.
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