Outcomes for Patients Undergoing Revascularization for Multivessel Acute Coronary Syndrome at High-Volume and...

To investigate outcomes in high-volume hospitals (HVH) versus non-HVH (NHVH), regardless of revascularization strategy.

This is a sub-analysis of a multi-centered, retrospective, observational study assessing outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in HVH versus NHVH hospitals. The primary endpoint was 1-year mortality, and secondary endpoints were death, MI, and stroke or transient ischemic attack (TIA) during admission, at 30 days, and at 1 year, 1-year readmission, and index length of stay.

Seven hundred thirty-eight patients from NHVHs and 1116 patients from HVHs were included in this study. Baseline demographics showed a higher proportion of males in the NHVH versus HVH group (73% vs. 67%) and a lower proportion of CABG (9% vs. 20%). The primary endpoint (death) was similar comparing NHVH to HVH hospitals (HR = 0.98 [95% CI 0.75-1.27], p = 0.85) as was MI (HR = 0.87 [95% CI 0.52-1.44] p = 0.58) and stroke or TIA (HR 1.28 [95% CI 0.18-6.98], p = 0.90). Readmission rates were numerically lower but not statistically significant between NHVH centers (HR = 0.85 [95% CI 0.69-1.04] p = 0.11), as was the median length of stay (3 days vs. 5 days, p < 0.001).

Patients with ACS found to have multivessel disease had similar 1-year mortality and repeat ACS whether they received care at an HVH or an NHVH. Yet, HVH patients had increased readmission rates, perhaps underscoring their complexity and comorbidities. This study demonstrates that certain patient populations without serious comorbidities may be managed at NHVH hospitals.