[Procedural outcome of percutaneous coronary angioplasty: hospital and operative volume]

The guidelines for percutaneous transluminal coronary angioplasty of the Scientific Societies establish the number of cases per Institution deemed essential to maintain quality and safe care. In this report, we try to demonstrate that the work-load of the individual operator is the best determinant of procedural outcome.

At our Institution, a single operator performed 445 coronary angioplasties during the years 1994-1997: we analyze the results, complications and costs of these procedures.

The overall initial success rate was 89.4% for single-lesion dilations (95.5% for stenosis, 70% for total occlusions). Major complications were 1 death during a procedure for cardiogenic shock (0.2%), 3 deaths during recovery in the cardiac surgery unit (0.7%), 2 acute myocardial infarctions (0.5%), no cerebrovascular events or coronary artery by-passes. Forty-four cases (11%) needed revascularization for restenosis within six months. The cost of each coronary angioplasty at our Institution was 6,600,000 Italian lire (inclusive of materials, fixed Cath. Lab. costs and hospitalization costs).

Our results show that it is possible to reach a high standard of efficiency in a low work-load interventional laboratory; to achieve this result, careful selection of patients, a valid peer review mechanism and a high work-load per a single operator, are required.