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The relationship between procedural volume and patient outcomes for percutaneous coronary interventions: a systematic

Kieran A Walsh1, Thomas Plunkett1, Kirsty K O'Brien1

  • 1Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland.

HRB Open Research
|April 12, 2021
PubMed

Insights

The relationship between percutaneous coronary interventions (PCI) procedural volume and patient outcomes is weakening. While high-volume operators and hospitals show benefits for specific PCI types, overall evidence certainty is very low.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • The association between procedural volume and outcomes for percutaneous coronary interventions (PCI) remains debated.
  • Previous reviews suggested an inverse volume-outcome relationship, necessitating a re-examination of contemporary evidence.

Approach:

  • A systematic review and meta-analysis was conducted on observational studies published between January 2008 and May 2019.
  • The review examined the relationship between PCI procedural volume (hospital and operator levels) and patient outcomes, focusing on mortality, complications, and healthcare utilization.
  • The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

Key Points:

  • No significant association was found between total PCI hospital volume and mortality (OR: 0.84, 95% CI: 0.69-1.03).
  • High-volume operators demonstrated a significant association with reduced mortality for total PCI procedures (OR: 0.77, 95% CI: 0.63-0.94).
  • High-volume hospitals showed a significant association with reduced mortality for primary PCI procedures (OR: 0.77, 95% CI: 0.62-0.94).
  • The certainty of the overall evidence was assessed as 'very low'.

Conclusions:

  • A volume-outcome relationship in PCI may exist but appears to be diminishing over time.
  • The certainty of evidence is very low, suggesting caution in its interpretation.
  • Volume alone should not define PCI service quality; a comprehensive evaluation of quality metrics, including patient experience and clinical outcomes, is recommended.
Abstract

Keywords:
PCISTEMISystematic reviewhealth services researchheart attackmeta-analysismyocardial infarction.volume-outcome

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