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Association between operator volume and mortality in primary percutaneous coronary intervention

Arvindra Krishnamurthy1,2, Claire M Keeble2,3, Michelle Anderson4

  • 1Department of Cardiology, Leeds General Infirmary, Leeds, UK arvindra@doctors.org.uk.

Open Heart
|October 3, 2022
PubMed

Insights

Low operator volume in primary percutaneous coronary intervention (PPCI) is linked to higher 30-day mortality. This suggests a volume-outcome relationship in PPCI procedures, potentially at a higher threshold than currently recommended.

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.
Abstract

Keywords:
Myocardial InfarctionPRIMARY PCIPercutaneous Coronary Intervention

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