Association between operator volume and mortality in primary percutaneous coronary intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Limited real-world data exists on the relationship between operator volume and mortality in primary percutaneous coronary intervention (PPCI).
• Understanding this association is crucial for optimizing patient outcomes and procedural safety.

Purpose of the Study:

• To investigate the association between annual operator volume and mortality rates following primary percutaneous coronary intervention (PPCI).
• To determine if a volume-outcome relationship exists and at what threshold.

Main Methods:

• Prospective data collection of patients undergoing PPCI from 2009-2013 at Leeds General Infirmary, UK.
• Categorization of operators into low (1-54), intermediate (55-109), and high (≥110) annual PPCI volumes.
• Cox proportional hazards regression analysis to assess 30-day and 12-month all-cause mortality, adjusting for confounders.

Main Results:

• PPCI performed by low-volume operators was associated with significantly higher adjusted 30-day mortality compared to high-volume operators (HR 1.48).
• No significant difference in adjusted 12-month mortality was observed between low-volume and high-volume operators.
• No significant mortality differences were found between low/intermediate and intermediate/high volume operator groups at 30 days or 12 months.

Conclusions:

• Low operator volume is an independent predictor of increased 30-day mortality after PPCI.
• A volume-outcome relationship in PPCI may exist at a higher operator volume threshold than currently recommended.
• Further research may inform guidelines on optimal operator volume for PPCI to improve patient survival.