TY - JOUR
T1 - Volume-outcome relationships for percutaneous coronary interventions in the stent era
AU - Hannan, Edward L.
AU - Wu, Chuntao
AU - Walford, Gary
AU - King, Spencer B.
AU - Holmes, David R.
AU - Ambrose, John A.
AU - Sharma, Samin
AU - Katz, Stanley
AU - Clark, Luther T.
AU - Jones, Robert H.
PY - 2005/8/23
Y1 - 2005/8/23
N2 - Background - Most studies that are the basis of recommended volume thresholds for percutaneous coronary interventions (PCIs) predate the routine use of stent placement. Methods and Results - Data from New York's Percutaneous Coronary Interventions Reporting System in 1998 to 2000 (n=107 713) were used to examine the impact of annual hospital volume and annual operator volume on in-hospital mortality, same-day coronary artery bypass graft (CABG) surgery, and same- stay CABG surgery after adjustment for differences in patients' severity of illness. For a hospital-volume threshold of 400, the odds ratios for low-volume hospitals versus high-volume hospitals were 1.98 (95% CI, 1.17, 3.35) for in-hospital mortality, 2.07 (95% CI, 1.36, 3.15) for same-day CABG surgery, and 1.51 (95% CI, 1.03, 2.21) for same-stay CABG surgery. For an operator-volume threshold of 75, the odds ratios for low-volume versus high-volume operators were 1.65 (95% CI, 1.05, 2.60) for same-day CABG surgery and 1.55 (95% CI, 1.10, 2.18) for same-stay CABG surgery. Operator volume was not significantly associated with mortality. Also, for hospital volumes below 400 and operator volumes below 75, the respective odds of mortality, same-day CABG surgery, and same-stay CABG surgery were 5.92, 4.02, and 3.92 times the odds for hospital volumes of 400 or higher and operator volumes of 75 or higher. Conclusions - Higher-volume operators and hospitals continue to experience lower risk-adjusted PCI outcome rates.
AB - Background - Most studies that are the basis of recommended volume thresholds for percutaneous coronary interventions (PCIs) predate the routine use of stent placement. Methods and Results - Data from New York's Percutaneous Coronary Interventions Reporting System in 1998 to 2000 (n=107 713) were used to examine the impact of annual hospital volume and annual operator volume on in-hospital mortality, same-day coronary artery bypass graft (CABG) surgery, and same- stay CABG surgery after adjustment for differences in patients' severity of illness. For a hospital-volume threshold of 400, the odds ratios for low-volume hospitals versus high-volume hospitals were 1.98 (95% CI, 1.17, 3.35) for in-hospital mortality, 2.07 (95% CI, 1.36, 3.15) for same-day CABG surgery, and 1.51 (95% CI, 1.03, 2.21) for same-stay CABG surgery. For an operator-volume threshold of 75, the odds ratios for low-volume versus high-volume operators were 1.65 (95% CI, 1.05, 2.60) for same-day CABG surgery and 1.55 (95% CI, 1.10, 2.18) for same-stay CABG surgery. Operator volume was not significantly associated with mortality. Also, for hospital volumes below 400 and operator volumes below 75, the respective odds of mortality, same-day CABG surgery, and same-stay CABG surgery were 5.92, 4.02, and 3.92 times the odds for hospital volumes of 400 or higher and operator volumes of 75 or higher. Conclusions - Higher-volume operators and hospitals continue to experience lower risk-adjusted PCI outcome rates.
KW - Angioplasty
KW - Coronary disease
KW - Mortality
KW - Revascularization
KW - Stents
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U2 - 10.1161/CIRCULATIONAHA.104.528455
DO - 10.1161/CIRCULATIONAHA.104.528455
M3 - Article
C2 - 16103238
AN - SCOPUS:24044486547
SN - 0009-7322
VL - 112
SP - 1171
EP - 1179
JO - Circulation
JF - Circulation
IS - 8
ER -