Outcomes for Patients Undergoing Revascularization for Multivessel Acute Coronary Syndrome at High-Volume and
Jacob Powel1, Kendall Hammonds2, Jose E Exaire3
1Texas A&M College of Medicine, Bryan, Texas, USA.
Insights
Outcomes for acute coronary syndrome (ACS) patients were similar in high-volume hospitals (HVH) and non-HVH (NHVH) regarding mortality and repeat ACS events. However, HVH patients experienced higher readmission rates, suggesting greater complexity.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Acute coronary syndrome (ACS) management varies across healthcare settings.
- Hospital volume is a potential factor influencing patient outcomes.
Purpose of the Study:
- To compare 1-year outcomes for ACS patients treated in high-volume hospitals (HVH) versus non-high-volume hospitals (NHVH).
- To evaluate the impact of hospital volume on mortality, major adverse cardiac events, and readmissions, irrespective of revascularization strategy.
Main Methods:
- A multi-centered, retrospective, observational study.
- Included patients with ACS undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
- Compared outcomes between HVH and NHVH, focusing on 1-year mortality, readmissions, and length of stay.
Main Results:
- No significant difference in 1-year mortality between NHVH and HVH (HR=0.98).
- Similar rates of myocardial infarction (MI) and stroke/transient ischemic attack (TIA) between groups.
- Numerically lower, but not statistically significant, readmission rates in NHVH (HR=0.85).
Conclusions:
- ACS patients with multivessel disease have comparable 1-year mortality and repeat ACS events in HVH and NHVH.
- Higher readmission rates in HVH may reflect greater patient complexity and comorbidities.
- Selected ACS patient populations without severe comorbidities can be safely managed in NHVH.
Objective:
To investigate outcomes in high-volume hospitals (HVH) versus non-HVH (NHVH), regardless of revascularization strategy.
Patients And Methods:
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.
Results:
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).
Conclusion:
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.
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