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Effect of Procedural Volume on In-Hospital Outcomes After Percutaneous Coronary Intervention in Patients With Chronic

Tsuyoshi Ito1, Kyohei Yamaji2, Shun Kohsaka3

  • 1Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

The American Journal of Cardiology
|December 11, 2021
PubMed

Insights

Higher institutional volume for percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD) is linked to better in-hospital outcomes. Focusing on institutional CKD-PCI volume can improve decision-making for revascularization in these high-risk patients.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Health Services Research

Background:

  • Chronic kidney disease (CKD) significantly elevates the risk of adverse outcomes in patients with cardiovascular diseases.
  • Percutaneous coronary intervention (PCI) is a common revascularization strategy, but outcomes may vary based on institutional experience, especially in CKD patients.
  • Understanding the relationship between institutional PCI volume and clinical outcomes in CKD patients is crucial for optimizing care.

Purpose of the Study:

  • To investigate the association between the annual institutional volume of percutaneous coronary intervention (PCI) performed in patients with chronic kidney disease (CKD).
  • To evaluate the impact of institutional CKD-PCI volume on in-hospital clinical outcomes, including death and periprocedural complications.
  • To determine if higher institutional volume correlates with improved procedural characteristics and patient outcomes.

Main Methods:

  • Analysis of a Japanese nationwide registry data from 2014-2018, including 1,199,901 PCI procedures.
  • Focus on 220,509 patients with CKD, categorized into quartiles based on mean annual institutional CKD-PCI volume.
  • Primary outcome: composite of in-hospital death and periprocedural complications. Secondary analysis of procedural characteristics like device use, contrast volume, access site, and door-to-balloon time.

Main Results:

  • Higher institutional CKD-PCI volume was associated with significantly lower rates of the primary composite outcome (3.4% in Q1 vs. 2.4% in Q4, p <0.001).
  • Institutions with the highest PCI volume demonstrated improved procedural efficiency, including lower contrast use, higher radial access rates, and shorter door-to-balloon times for STEMI.
  • An inverse relationship was observed: higher institutional CKD-PCI volume correlated with reduced odds of adverse in-hospital events (OR for Q4 vs. Q1: 0.76 [0.84 to 0.97]).

Conclusions:

  • Institutional volume of percutaneous coronary intervention (PCI) significantly influences procedural characteristics and in-hospital outcomes for patients with chronic kidney disease (CKD).
  • Higher-volume institutions are associated with better clinical results and procedural efficiency in CKD patients undergoing PCI.
  • Institutional CKD-PCI volume should be a key consideration in clinical decision-making for revascularization strategies in patients with CKD.

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