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Tokuda T, Takahara M, Iida O, Kohsaka S, Soga Y, Oba Y, Hirano K, Shinke T, Amano T, Ikari Y. Institutional Volume and Initial Results for Endovascular Treatment for Chronic Occlusive Lower-Extremity Artery Disease: A Report From the Japanese Nationwide Registry. J Endovasc Ther 2024; 31:975-983. [PMID: 36935577 DOI: 10.1177/15266028231161242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE Chronic total occlusion (CTO) remains as a major target for endovascular treatment (EVT) in improving symptomatic lower-extremity artery disease (LEAD). However, despite the technical demand and learning curve for the procedure, volume-outcome relationship of EVT targeted for CTO in symptomatic LEAD remains unclear. MATERIALS AND METHODS Data were obtained from a nationwide registry for EVT procedures limited to the Japanese Association of Cardiovascular Intervention and Therapeutics between January 2018 and December 2020 from 660 cardiovascular centers in Japan. In total, 96 099 patients underwent EVT for symptomatic LEAD, and 41 900 (43.6%) underwent CTO-targeted EVTs during the study period. Institutional volume was classified into quartiles. The association of institutional volumes with short-term outcomes was explored using the generalized linear mixed model using a logit link function, in which, interinstitution variability was used as a random effect. RESULTS The median institutional volume for all EVT cases per quartile was 29, 68, 125, and 299 cases/year for the first, second, third, and fourth quartiles, respectively. With each model analysis, the adjusted odds ratios (ORs) for technical success were significantly lower in patients who underwent EVT in institutions within the first quartile (<52 cases/year) than in the other quartiles (P < .01, respectively). On the contrary, the adjusted ORs for procedural complications were significantly higher in the first and second quartiles than in the third and fourth quartiles (P < .01, respectively). CONCLUSION In contemporary Japanese EVT practice, a higher institutional volume but not operator volume was associated with a higher technical success rate and a lower procedural complication rate in patients with symptomatic LEAD involving CTO lesions. CLINICAL IMPACT EVT for CTO lesions is still challenging for clinicians because of difficulties of wire/devise crossing or high procedural complications rate. Our study demonstrated that a higher institutional volume but not operator volume was associated with a higher technical success rate and a lower procedural complication rate in patients with symptomatic LEAD involving CTO lesions. In contemporary Japanese practice, a higher institutional experience has better impacts on short-term clinical outcomes. Future research should determine the relationship between institutional volume and long-term clinical outcomes.
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Affiliation(s)
- Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Shun Kohsaka
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yasuhiro Oba
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Keisuke Hirano
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Toshiro Shinke
- Department of Cardiology, School of Medicine, Showa University, Tokyo, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yuji Ikari
- Division of Cardiovascular Medicine, Tokai University Hospital, Isehara, Japan
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Januszek R, Bryniarski L, Mashayekhi K, DI Mario C, Siłka W, Malinowski KP, Wańha W, Chyrchel M, Siudak Z. Annual operator volume and procedural outcomes of chronic total occlusions treated with percutaneous coronary interventions: analysis based on 14,899 patients. Minerva Cardiol Angiol 2024; 72:336-345. [PMID: 38482633 DOI: 10.23736/s2724-5683.23.06447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND Low operator and institutional volume is associated with poorer procedural and long-term clinical outcomes in patients treated with percutaneous coronary interventions (PCI). This study was aimed at evaluating the relationship between operator volume and procedural outcomes of patients treated with PCI for chronic total occlusion (CTO). METHODS Data were obtained from the national registry of percutaneous coronary interventions (ORPKI) collected from January 2014 to December 2020. The primary endpoint was a procedural success, defined as restoration of thrombolysis in myocardial infarction (TIMI) II/III flow without in-hospital cardiac death and myocardial infarction, whereas secondary endpoints included periprocedural complications. RESULTS Data of 14,899 CTO-PCIs were analyzed. The global procedural success was 66.1%. There was a direct relationship between the annual volume of CTO-PCIs per operator and the procedural success (OR: 1.006 [95% CI: 1.003-1.009]; P<0.001). The nonlinear relationships of annualized CTO-PCI volume per operator and adjusted outcome rates revealed that operators performing 40 CTO cases per year had the best procedural outcomes in terms of technical success (TIMI flow II/III after PCI), coronary artery perforation rate and any periprocedural complications rate (P<0.0001). Among the other factors associated with procedural success, the following can be noted: multi-vessel, left main coronary artery disease (as compared to single-vessel disease), the usage of rotablation as well as PCI within bifurcation. CONCLUSIONS High-volume CTO operators achieve greater procedural success with a lower frequency of periprocedural complications. Higher annual caseload might increase the overall quality of CTO-PCI.
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Affiliation(s)
- Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland -
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Kraków, Poland -
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carlo DI Mario
- Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Wojciech Siłka
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof P Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Ju JW, Lee HJ, Nam K, Kim S, Hong H, Yoo SH, Lee S, Cho YJ, Jeon Y. Volatile Anesthetic Use Versus Total Intravenous Anesthesia for Patients Undergoing Heart Valve Surgery: A Nationwide Population-Based Study. Anesth Analg 2024; 139:114-123. [PMID: 38885399 DOI: 10.1213/ane.0000000000006760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Many studies have suggested that volatile anesthetic use may improve postoperative outcomes after cardiac surgery compared to total intravenous anesthesia (TIVA) owing to its potential cardioprotective effect. However, the results were inconclusive, and few studies have included patients undergoing heart valve surgery. METHODS This nationwide population-based study included all adult patients who underwent heart valve surgery between 2010 and 2019 in Korea based on data from a health insurance claim database. Patients were divided based on the use of volatile anesthetics: the volatile anesthetics or TIVA groups. After stabilized inverse probability of treatment weighting (IPTW), the association between the use of volatile anesthetics and the risk of cumulative 1-year all-cause mortality (the primary outcome) and cumulative long-term (beyond 1 year) mortality were assessed using Cox regression analysis. RESULTS Of the 30,755 patients included in this study, the overall incidence of 1-year mortality was 8.5%. After stabilized IPTW, the risk of cumulative 1-year mortality did not differ in the volatile anesthetics group compared to the TIVA group (hazard ratio, 0.98; 95% confidence interval, 0.90-1.07; P = .602), nor did the risk of cumulative long-term mortality (hazard ratio, 0.98; 95% confidence interval, 0.93-1.04; P = .579) at a median (interquartile range) follow-up duration of 4.8 (2.6-7.6) years. CONCLUSIONS Compared with TIVA, volatile anesthetic use was not associated with reduced postoperative mortality risk in patients undergoing heart valve surgery. Our findings indicate that the use of volatile anesthetics does not have a significant impact on mortality after heart valve surgery. Therefore, the choice of anesthesia type can be based on the anesthesiologists' or institutional preference and experience.
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Affiliation(s)
- Jae-Woo Ju
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jin Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Karam Nam
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Ho Yoo
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seohee Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn Joung Cho
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yunseok Jeon
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lišnić V, Ashraf H, Viđak M, Marušić A. Completeness of intervention description in invasive cardiology trials: an observational study of ClinicalTrials.gov registry and corresponding publications. Front Med (Lausanne) 2023; 10:1276847. [PMID: 37881632 PMCID: PMC10597631 DOI: 10.3389/fmed.2023.1276847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Non-pharmacological invasive interventions in cardiology are complex and often inadequately reported. Template for Intervention Description and Replication (TIDieR) checklist and guide were developed to aid reporting and assessment of non-pharmacological interventions. The aim of our study was to assess the completeness of describing invasive cardiology interventions in clinical trials at the level of trial registration and corresponding journal article publication. Methodology We searched for clinical trials in invasive cardiology registered in Clinicaltrials.gov and corresponding journal publications. We used the 10-item TIDieR checklist for registries and 12-item checklist for journal publications. Results Out of 7,017 registry items retrieved by our search, 301 items were included in the analysis. The search for corresponding published articles yielded 192 journal publications. The majority of trials were funded by the industry and were medical device trials. The median number of reported TIDieR items was 4.5 (95% CI 4.49-4.51) out of 10, and while the corresponding journal articles reported 6.5 (95% CI 6.0-6.5) out of 12 TIDieR items. Conclusion Registration and reporting of invasive cardiology trials is often incomplete and adequate detailed description of the interventions is not provided. TIDieR checklist is an important tool which should be used to ensure rigorous reporting of non-pharmacological interventions in cardiology.
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Affiliation(s)
- Viktoria Lišnić
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | - Hishaam Ashraf
- Wirral University Teaching Hospital, Wirral, United Kingdom
| | - Marin Viđak
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Split, Croatia
- Department of Cardiology, Dubrava University Hospital, Zagreb, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Split, Croatia
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Lima HA, Moazzam Z, Woldesenbet S, Alaimo L, Endo Y, Munir MM, Shaikh CF, Resende V, Pawlik TM. Persistence of Poverty and its Impact on Surgical Care and Postoperative Outcomes. Ann Surg 2023; 278:347-356. [PMID: 37317875 DOI: 10.1097/sla.0000000000005953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We sought to characterize the association between prolonged county-level poverty with postoperative outcomes. BACKGROUND The impact of long-standing poverty on surgical outcomes remains ill-defined. METHODS Patients who underwent lung resection, colectomy, coronary artery bypass graft, or lower extremity joint replacement were identified from Medicare Standard Analytical Files Database (2015-2017) and merged with data from the American Community Survey and the United States Department of Agriculture. Patients were categorized according to the duration of high poverty status from 1980 to 2015 [ie, never high poverty (NHP), persistent poverty (PP)]. Logistic regression was used to characterize the association between the duration of poverty and postoperative outcomes. Principal component and generalized structural equation modeling were used to assess the effect of mediators in the achievement of Textbook Outcomes (TO). RESULTS Overall, 335,595 patients underwent lung resection (10.1%), colectomy (29.4%), coronary artery bypass graft (36.4%), or lower extremity joint replacement (24.2%). While 80.3% of patients lived in NHP, 4.4% resided in PP counties. Compared with NHP, patients residing in PP were at increased risk of serious postoperative complications [odds ratio (OR)=1.10, 95% CI: 1.05-1.15], 30-day readmission (OR=1.09, 95% CI: 1.01-1.16), 30-day mortality (OR=1.08, 95% CI: 1.00-1.17), and higher expenditures (mean difference, $1010.0, 95% CI: 643.7-1376.4) (all P <0.05). Notably, PP was associated with lower odds of achieving TO (OR=0.93, 95% CI: 0.90-0.97, P <0.001); 65% of this effect was mediated by other social determinant factors. Minority patients were less likely to achieve TO (OR=0.81, 95% CI: 0.79-0.84, P <0.001), and the disparity persisted across all poverty categories. CONCLUSIONS County-level poverty duration was associated with adverse postoperative outcomes and higher expenditures. These effects were mediated by various socioeconomic factors and were most pronounced among minority patients.
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Affiliation(s)
- Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Muhammad M Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Chanza F Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Vivian Resende
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
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Chadow D, Audisio K, Perezgrovas-Olaria R, Cancelli G, Robinson NB, Rahouma M, Soletti G, Angiolillo DJ, Metkus TS, Gaudino MFL. Differences Among Clinical Trials and Registries on Surgical and Percutaneous Coronary Interventions. Ann Thorac Surg 2023; 115:79-86. [PMID: 35643330 DOI: 10.1016/j.athoracsur.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/19/2022] [Accepted: 05/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND A need exists for systematic evaluation of the differences in baseline characteristics and early outcomes between patients enrolled in randomized controlled trials (RCTs) and clinical practice for coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). METHODS Systematic searches were conducted to identify RCTs comparing CABG vs PCI and CABG or PCI registries. Sixteen predefined baseline characteristics and 30-day mortality were extracted from the included studies. Pooled proportion and mean with 95% CI were calculated for binary and continuous outcomes, respectively, by using the random effects model. RESULTS Fourteen RCTs and 10 registries including more than 2 million patients were included. Registry patients who underwent CABG had a higher prevalence of hypertension, smoking, reduced left ventricular ejection fraction, and prior myocardial infarction, but a lower prevalence of single-vessel disease when compared with CABG-treated patients included in RCTs. Regarding PCI, hypertension, hyperlipidemia, left main coronary artery disease, triple-vessel coronary disease, and NYHA functional class <IV were significantly more prevalent among patients in RCTs, whereas age, reduced left ventricular ejection fraction, and smoking were more represented among PCI registry patients. Thirty-day mortality was higher in registries for both PCI-treated and CABG-treated patients. CONCLUSIONS There were significant differences in baseline characteristics and 30-day mortality between patients enrolled in RCTs comparing CABG vs PCI and CABG and PCI registries. However, results were mixed, and the discrepancy was less than seen in other fields.
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Affiliation(s)
- David Chadow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | | | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Thomas S Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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7
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Lima FV, Kennedy KF, Saad M, Kolte D, Foley K, Abbott JD, Aronow HD. In-hospital Outcomes and Cost Associated With Treatments for Non-ST-elevation Myocardial Infarction. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100532. [PMID: 39132525 PMCID: PMC11307865 DOI: 10.1016/j.jscai.2022.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 08/13/2024]
Abstract
Background Although variation in the management of patients with non-ST-elevation myocardial infarction (NSTEMI) is well documented across US hospitals, few data exist characterizing variation in outcomes following specific management strategies. Methods Admissions for NSTEMI to hospitals performing coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery between 2016 and 2018 were identified from the National Inpatient Sample. Patients were categorized according to treatment rendered (medical therapy alone, angiography without revascularization, PCI, or CABG). The primary end point was variation in the incidence of composite in-hospital death, postprocedure myocardial infarction, or stroke, stratified by treatment rendered. Secondary outcomes included variation in length of stay (LOS), cost, and use of each treatment modality. Variation was characterized by the median odds ratio. Results Among 140,194 hospitalizations for NSTEMI, 35,748 (25.5%) patients received medical therapy alone, 28,678 (20.5%) underwent angiography without revascularization, 58,383 (41.6%) underwent PCI, and 17,385 (12.4%) underwent CABG. Despite adjusting for patient- and hospital-related factors, 2 similar patients were 25% more likely to experience the composite primary outcome following PCI and 45% more likely following CABG at 1 randomly selected hospital than at another. Significant hospital-level variations in LOS and cost were also apparent following each treatment modality. Conclusions In a large national analysis of hospitalizations for NSTEMI, significant variation was observed in clinical outcome, LOS, and cost associated with each treatment modality, despite adjustment for patient- and hospital-related factors.
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Affiliation(s)
- Fabio V. Lima
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Marwan Saad
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Katelyn Foley
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - J. Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Herbert D. Aronow
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Heart & Vascular Services, Henry Ford Health, Detroit, Michigan
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Krishnamurthy A, Keeble CM, Anderson M, Burton-Wood N, Somers K, Harland C, Baxter PD, McLenachan JM, Blaxill JM, Blackman DJ, Malkin CJ, Wheatcroft SB, Greenwood JP. Association between operator volume and mortality in primary percutaneous coronary intervention. Open Heart 2022; 9:openhrt-2022-002072. [PMID: 36192035 PMCID: PMC9535214 DOI: 10.1136/openhrt-2022-002072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
Background There is a paucity of real-world data assessing the association of operator volumes and mortality specific to primary percutaneous coronary intervention (PPCI). Methods Demographic, clinical and outcome data for all patients undergoing PPCI in Leeds General Infirmary, UK, between 1 January 2009 and 31 December 2011, and 1 January 2013 and 31 December 2013, were obtained prospectively. Operator volumes were analysed according to annual operator PPCI volume (low volume: 1–54 PPCI per year; intermediate volume: 55–109 PPCI per year; high volume: ≥110 PPCI per year). Cox proportional hazards regression analyses were undertaken to investigate 30-day and 12-month all-cause mortality, adjusting for confounding factors. Results During this period, 4056 patients underwent PPCI, 3703 (91.3%) of whom were followed up for a minimum of 12 months. PPCI by low-volume operators was associated with significantly higher adjusted 30-day mortality (HR 1.48 (95% CI 1.05 to 2.08); p=0.02) compared with PPCI performed by high-volume operators, with no significant difference in adjusted 12-month mortality (HR 1.26 (95% CI 0.96 to 1.65); p=0.09). Comparisons between low-volume and intermediate-volume operators, and between intermediate and high-volume operators, showed no significant differences in 30-day and 12-month mortality. Conclusions Low operator volume is independently associated with higher probability of 30-day mortality compared with high operator volume, suggesting a volume–outcome relationship in PPCI at a threshold higher than current recommendations.
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Affiliation(s)
- Arvindra Krishnamurthy
- Department of Cardiology, Leeds General Infirmary, Leeds, UK,Leeds Instutute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Claire M Keeble
- Leeds Instutute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK,Leeds Institute of Data Analytics, Leeds, UK
| | | | | | - Kathryn Somers
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | | | - Paul D Baxter
- Leeds Instutute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK,Leeds Institute of Data Analytics, Leeds, UK
| | | | | | | | | | - Stephen B Wheatcroft
- Department of Cardiology, Leeds General Infirmary, Leeds, UK,Leeds Instutute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Department of Cardiology, Leeds General Infirmary, Leeds, UK,Leeds Instutute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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9
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Ito T, Yamaji K, Kohsaka S, Ishii H, Wada H, Amano T, Fujita H, Seo Y, Ikari Y. Effect of Procedural Volume on In-Hospital Outcomes After Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease (from the Japanese National Clinical Data [J-PCI Registry]). Am J Cardiol 2022; 165:12-18. [PMID: 34893300 DOI: 10.1016/j.amjcard.2021.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
Chronic kidney disease (CKD) increases the risk of death and other poor outcomes in patients with cardiovascular diseases. This study investigated the relation between the institutional CKD percutaneous coronary intervention (PCI) volume and in-hospital clinical outcomes in patients with CKD. Among 1,199,901 patients who underwent PCI in 2014 to 2018 from the Japanese nationwide registry, we analyzed 220,509 patients with CKD. Patients were classified into quartiles (Q) according to the mean annual institutional CKD-PCI volume (Q1 <42 PCIs/year, Q2 <74 PCIs/year, Q3 <124 PCIs/year, Q4 ≥125 PCIs/year). The primary outcome was a composite of in-hospital death and periprocedural complications. The mean age of patients was 73 ± 10 years, and 36% (n = 78,332) were on dialysis. PCI was more likely to be performed with rotational atherectomy devices in high-volume institutions. Contrast volume was lower, the rate of radial access PCI was higher, and door-to-balloon time (for ST-elevation myocardial infarction) was shorter in the highest quartile institutions. Primary outcomes were observed in 6,539 patients (3.0%). The crude rate of the primary outcome was lowest in institutions with the highest PCI volume (Q1 3.4%, Q2 3.0%, Q3 3.0%, Q4 2.4%, p <0.001); higher PCI volume was associated with reduced frequency of the primary outcome (odds ratio [95% confidence interval] relative to Q1:Q2, 0.89 [0.83 to 0.96]; Q3 0.90 [0.84 to 0.97]; and Q4 0.76 [0.84 to 0.97]). In conclusion, the procedural characteristics and outcomes of PCI differed significantly by institutional volume in patients with CKD. When considering revascularization among these patients, institutional CKD-PCI volume needs to be incorporated in decision-making.
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Affiliation(s)
- Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka, Hospital Shizuoka Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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11
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Sawayama Y, Yamaji K, Kohsaka S, Yamamoto T, Higo Y, Numasawa Y, Inohara T, Ishii H, Amano T, Ikari Y, Nakagawa Y. Variation in in-hospital mortality and its association with percutaneous coronary intervention-related bleeding complications: A report from nationwide registry in Japan. PLoS One 2021; 16:e0261371. [PMID: 34898658 PMCID: PMC8668123 DOI: 10.1371/journal.pone.0261371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Large-scale registries have demonstrated that in-hospital mortality after percutaneous coronary intervention (PCI) varies widely across institutions. However, whether this variation is related to major procedural complications (e.g., bleeding) is unclear. In this study, institutional variation in in-hospital mortality and its association with PCI-related bleeding complications were investigated. We analyzed 388,866 procedures at 718 hospitals performed from 2017 to 2018, using data from a nationwide PCI registry in Japan. Hospitals were stratified into quintiles according to risk-adjusted in-hospital mortality (very low, low, medium, high, and very high). Incidence of bleeding complications, defined as procedure-related bleeding events that required a blood transfusion, and in-hospital mortality in patients who developed bleeding complications were calculated for each quintile. Overall, 4,048 (1.04%) in-hospital deaths and 1,535 (0.39%) bleeding complications occurred. Among patients with bleeding complications, 270 (17.6%) died during hospitalization. In-hospital mortality ranged from 0.22% to 2.46% in very low to very high mortality hospitals. The rate of bleeding complications varied modestly from 0.27% to 0.57% (odds ratio, 1.95; 95% confidence interval, 1.58–2.39). However, mortality after bleeding complications markedly increased by quintile and was 6-fold higher in very high mortality hospitals than very low mortality hospitals (29.0% vs. 4.8%; odds ratio, 12.2; 95% confidence interval, 6.90–21.7). In conclusion, institutional variation in in-hospital mortality after PCI was associated with procedure-related bleeding complications, and this variation was largely driven by differences in mortality after bleeding complications rather than difference in their incidence. These findings underscore the importance of efforts toward reducing not only bleeding complications but also, even more importantly, subsequent mortality once they have occurred.
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Affiliation(s)
- Yuichi Sawayama
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Yamamoto
- Department of Cardiovascular Medicine, Kohka Public Hospital, Kohka, Japan
| | - Yosuke Higo
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
- * E-mail:
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12
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Kovach CP, O'Donnell CI, Swat S, Doll JA, Plomondon ME, Schofield R, Valle JA, Waldo SW. Impact of operator volumes and experience on outcomes after percutaneous coronary intervention: Insights from the Veterans Affairs Clinical Assessment, Reporting and Tracking (CART) program. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:64-68. [PMID: 34774419 DOI: 10.1016/j.carrev.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent analyses of the volume-outcome relationship for percutaneous coronary intervention (PCI) have suggested a less robust association than previously reported. It is unknown if novel factors such as lifetime operator experience influence this relationship. OBJECTIVES To assess the relationship between annual volumes and outcomes for PCI and determine whether lifetime operator experience modulates the association. METHODS Annual PCI volumes for facilities and operators within the Veterans Affairs Healthcare System and their relationship with 30-day mortality following PCI were described. The influence of operator lifetime experience on the volume-outcome relationship was assessed. Hierarchical logistic regression was used to adjust for patient and procedural factors. RESULTS 57,608 PCIs performed from 2013 to 2018 by 382 operators and 63 institutions were analyzed. Operator annualized PCI volume averaged 47.6 (standard deviation [SD] 49.1) and site annualized volume averaged 189.2 (SD 105.2). Median operator experience was 9.0 years (interquartile range [IQR] 4.0-15.0). There was no independent relationship between operator annual volume, institutional volume, or operator lifetime experience with 30-day mortality (p > 0.10). However, the interaction between operator volume and lifetime experience was associated with a marginal decrease in mortality (odds ratio [OR] 0.9998, 95% CI 0.9996-0.9999). CONCLUSIONS There were no significant associations between facility or operator-level procedural volume and 30-day mortality following PCI in a nationally integrated healthcare system. There was a marginal association between the interaction of operator lifetime experience, operator annual volume, and 30-day mortality that is unlikely to be clinically relevant, though does suggest an opportunity to explore novel factors that may influence the volume-outcome relationship.
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Affiliation(s)
- Christopher P Kovach
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, United States of America
| | - Colin I O'Donnell
- Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, United States of America; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, United States of America
| | - Stanley Swat
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, United States of America
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States of America; Department of Medicine, Puget Sound VA Medical Center, Seattle, WA, United States of America
| | - Mary E Plomondon
- Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, United States of America; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, United States of America
| | - Richard Schofield
- University of Florida College of Medicine, Gainesville, FL, United States of America; Department of Veterans Affairs Medical Center, Gainesville, FL, United States of America
| | - Javier A Valle
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, United States of America; Michigan Heart and Vascular Institute, Ann Arbor, MI, United States of America
| | - Stephen W Waldo
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, United States of America; Department of Medicine, Rocky Mountain VA Medical Center, Aurora, CO, United States of America; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, United States of America.
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13
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Kovoor JG, Ma N, Tivey DR, Vandepeer M, Jacobsen JHW, Scarfe A, Vreugdenburg TD, Stretton B, Edwards S, Babidge WJ, Anthony AA, Padbury RTA, Maddern GJ. In-hospital survival after pancreatoduodenectomy is greater in high-volume hospitals versus lower-volume hospitals: a meta-analysis. ANZ J Surg 2021; 92:77-85. [PMID: 34676647 DOI: 10.1111/ans.17293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Variation in cut-off values for what is considered a high volume (HV) hospital has made assessments of volume-outcome relationships for pancreaticoduodenectomy (PD) challenging. Accordingly, we performed a systematic review and meta-analysis comparing in-hospital mortality after PD in hospitals above and below HV thresholds of various cut-off values. METHOD PubMed/MEDLINE, Embase and Cochrane Library were searched to 4 January 2021 for studies comparing in-hospital mortality after PD in hospitals above and below defined HV thresholds. After data extraction, risk of bias was assessed using the Downs and Black checklist. A random-effects model was used for meta-analysis, including meta-regressions. Registration: PROSPERO, CRD42021224432. RESULTS From 1855 records, 17 observational studies of moderate quality were included. Median HV cut-off was 25 PDs/year (IQR: 20-32). Overall relative risk of in-hospital mortality was 0.37 (95% CI: 0.30, 0.45), that is, 63% less in HV hospitals. All subgroup analyses found an in-hospital survival benefit in performing PDs at HV hospitals. Meta-regressions from included studies found no statistically significant associations between relative risk of in-hospital mortality and region (USA vs. non-USA; p = 0.396); or 25th percentile (p = 0.231), median (p = 0.822) or 75th percentile (p = 0.469) HV cut-off values. Significant inverse relationships were found between PD hospital volume and other outcomes. CONCLUSION In-hospital survival was significantly greater for patients undergoing PDs at HV hospitals, regardless of HV cut-off value or region. Future research is required to investigate regions where low-volume centres have specialized PD infrastructure and the potential impact on mortality.
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Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Ning Ma
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - David R Tivey
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Meegan Vandepeer
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Jonathan Henry W Jacobsen
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Anje Scarfe
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Thomas D Vreugdenburg
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Adrian A Anthony
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert T A Padbury
- Flinders University, Adelaide, South Australia, Australia.,Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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14
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Schrage B, Zeymer U, Montalescot G, Windecker S, Serpytis P, Vrints C, Stepinska J, Savonitto S, Oldroyd KG, Desch S, Fuernau G, Huber K, Noc M, Schneider S, Ouarrak T, Blankenberg S, Thiele H, Clemmensen P. Impact of Center Volume on Outcomes in Myocardial Infarction Complicated by Cardiogenic Shock: A CULPRIT-SHOCK Substudy. J Am Heart Assoc 2021; 10:e021150. [PMID: 34622680 PMCID: PMC8751884 DOI: 10.1161/jaha.120.021150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Little is known about the impact of center volume on outcomes in acute myocardial infarction complicated by cardiogenic shock. The aim of this study was to investigate the association between center volume, treatment strategies, and subsequent outcome in patients with acute myocardial infarction complicated by cardiogenic shock. Methods and Results In this subanalysis of the randomized CULPRIT‐SHOCK (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock) trial, study sites were categorized based on the annual volume of acute myocardial infarction complicated by cardiogenic shock into low‐/intermediate‐/high‐volume centers (<50; 50–100; and >100 cases/y). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment, and 1‐year all‐cause mortality were compared across categories. n=1032 patients were included in this study (537 treated at low‐volume, 240 at intermediate‐volume, and 255 at high‐volume centers). Baseline risk profile of patients across the volume categories was similar, although high‐volume centers included a larger number of older patients. Low‐/intermediate‐volume centers had more resuscitated patients (57.5%/58.8% versus 42.2%; P<0.01), and more patients on mechanical ventilation in comparison to high‐volume centers. There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies. There was no difference in 1‐year all‐cause mortality across volume categories (51.1% versus 56.5% versus 54.4%; P=0.34). Conclusions In this study of patients with acute myocardial infarction complicated by cardiogenic shock, considerable differences in adjunctive medical and mechanical support therapies were observed. However, we could not detect an impact of center volume on reperfusion success or mortality.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Uwe Zeymer
- Department of Cardiology Klinikum der Stadt Ludwigshafen Ludwigshafen am Rhein Germany
| | - Gilles Montalescot
- Sorbonne UniversityACTION Study GroupINSERM UMRS 1166Institut de CardiologieHôpital Pitié-Salpêtrière (AP-HP) Paris France
| | - Stephan Windecker
- Department of Cardiology Bern University HospitalInselspitalUniversity of Bern Bern Switzerland
| | - Pranas Serpytis
- Clinic of Emergency Medicine Faculty of Medicine VIilnius University Lithuania
| | | | - Janina Stepinska
- Department of the Intensive Cardiac Therapy National Institute of Cardiology Warsaw Poland
| | | | - Keith G Oldroyd
- West of Scotland Regional Heart and Lung Centre Golden Jubilee National Hospital Glasgow United Kingdom
| | - Steffen Desch
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Luebeck Germany
| | - Georg Fuernau
- Medical Clinic II (Cardiology, Angiology Intensive Care Medicine) University Heart Center Luebeck Luebeck Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Luebeck Germany
| | - Kurt Huber
- 3rd Department of Medicine Cardiology and Intensive Care Medicine Wilhelminenhospital and Sigmund Freud UniversityMedical Faculty Vienna Austria
| | - Marko Noc
- Center for Intensive Internal MedicineUniversity Medical Center Ljubljana Slovenia
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany
| | - Stefan Blankenberg
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig Germany
| | - Peter Clemmensen
- Department of Cardiology University Heart and Vascular Centre Hamburg Hamburg Germany.,Department of Regional Research and Department of Medicine Faculty of Health Sciences Nykoebing F HospitalUniversity of Southern Denmark Odense Denmark
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15
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Lv J, Zhao Q, Yang J, Gao X, Zhang X, Ye Y, Dong Q, Fu R, Sun H, Yan X, Li W, Yang Y, Xu H. Length of Stay and Short-Term Outcomes in Patients with ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention: Insights from the China Acute Myocardial Infarction Registry. Int J Gen Med 2021; 14:5981-5991. [PMID: 34588802 PMCID: PMC8473847 DOI: 10.2147/ijgm.s330379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Length of stay (LOS) in patients with ST-segment elevation myocardial infarction (STEMI) is directly associated with financial pressure and medical efficiency. This study aimed to determine impact of LOS on short-term outcomes and associated factors of LOS in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). METHODS A total of 3615 patients with STEMI after PPCI in the China Acute Myocardial Infarction registry were included in the analysis. Predictors of prolonged LOS were analyzed by multivariate logistic regression model with generalized estimating equation. The impact of LOS on 30-day clinical outcomes was assessed. RESULTS The median LOS was 9 (7, 12) days. Patients with a longer LOS (>7 days) were older, more often in lower-level hospitals, had more periprocedural complications and hospitalization expense. Fourteen variables, such as weekend admission and lower-level hospitals, were identified as independent associated factors of prolonged LOS. There were no significant difference in 30-day major adverse cardiac and cerebrovascular events (MACCE), readmission, and functional status between patients with LOS≤7d and LOS>7d after multivariate adjustment and propensity score matching. However, patients who discharged over one week had better medication adherence (adjusted odds ratio: 0.817, 95% confidence interval: 0.687-0.971, P=0.022). Significant interaction was observed in medication use between gender and LOS (Pinteraction=0.038). CONCLUSION Patients with STEMI undergoing PPCI experienced a relatively long LOS in China, which resulted in more medical expenses but no improvement on 30-day MACCE, readmission, and functional recovery. Poor 30-day medication adherence with short LOS reflects unsatisfying transition of management from hospital to community. More efforts are needed to reduce LOS safely and improve the efficiency of medical care.
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Affiliation(s)
- Junxing Lv
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Qinghao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Jingang Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Xiaojin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Xuan Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Yunqing Ye
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Qiuting Dong
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Rui Fu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Hui Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Xinxin Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Wei Li
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Haiyan Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - On behalf of the China Acute Myocardial Infarction Registry Study Group
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
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16
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Rapetto F, Bruno VD, Rajakaruna C, Bryan AJ, Parry AJ, Caputo M, Stoica SC. Adult coronary artery bypass grafting by congenital surgeons-a propensity matched analysis. Eur J Cardiothorac Surg 2021; 60:354-360. [PMID: 33585898 PMCID: PMC8573332 DOI: 10.1093/ejcts/ezab081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Surgical myocardial revascularization will be increasingly needed in adult patients with congenital heart disease. We investigated the results of coronary artery bypass grafting (CABG) performed on adults by congenital cardiac surgeons at our institution. METHODS We conducted a retrospective, single-centre study. Adults undergoing isolated or combined CABG from 2004 to 2017 were included. Early and late outcomes were analyzed for the whole cohort. Furthermore, a propensity matched analysis was conducted comparing the results of isolated CABG between congenital and adult surgeons. RESULTS A total of 514 and 113 patients had isolated and combined CABG for acquired heart disease, respectively. A total of 33 patients had myocardial revascularization at the time of surgery for congenital heart disease. Overall early mortality was 1.2%, the rate of re-exploration for bleeding was 4.5%, and an internal mammary artery to left anterior descending artery graft was used in 85.6% patients. One-year survival was 97.5% (96.2-98.8%), and 5-year survival was 88.0% (84.8-91.3%). After propensity matching (468 pairs), early mortality (0.6% vs 1.2%, P = 0.51), re-exploration for bleeding (3.6% vs 3.0%, P = 0.72), use of internal mammary artery to left anterior descending artery graft (92.7% vs 91.9%, P = 0.70) and late survival did not differ between congenital surgeons and adult surgeons, respectively. CONCLUSIONS Surgical myocardial revascularization can be required for adult congenital patients in a broad spectrum of clinical situations. Despite lower volumes, congenital cardiac surgeons perform CABG safely and with results that are comparable to those of the adult surgeons at our centre.
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Affiliation(s)
- Filippo Rapetto
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Vito D Bruno
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Cha Rajakaruna
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Alan J Bryan
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Andrew J Parry
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Serban C Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
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17
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Serruys PW, Ono M, Garg S, Hara H, Kawashima H, Pompilio G, Andreini D, Holmes DR, Onuma Y, King Iii SB. Percutaneous Coronary Revascularization: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2021; 78:384-407. [PMID: 34294273 DOI: 10.1016/j.jacc.2021.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 01/09/2023]
Abstract
Over the last 4 decades, percutaneous coronary intervention has evolved dramatically and is now an acceptable treatment option for patients with advanced coronary artery disease. However, trialists have struggled to establish the respective roles for percutaneous coronary intervention and coronary artery bypass graft surgery, especially in patients with multivessel disease and unprotected left-main stem coronary artery disease. Several pivotal trials and meta-analyses comparing these 2 revascularization strategies have enabled the relative merits of each technique to be established with regard to the type of ischemic syndrome, the coronary anatomy, and the patient's overall comorbidity. Precision medicine with individualized prognosis is emerging as an important method of selecting treatment. However, the never-ending advancement of technology, in conjunction with the emergence of novel pharmacological agents, will in the future continue to force us to reconsider the evolving question: "Which treatment strategy is better and for which patient?"
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Affiliation(s)
- Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland
| | - Spencer B King Iii
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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18
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Walsh KA, Plunkett T, O'Brien KK, Teljeur C, Smith SM, Harrington P, Ryan M. The relationship between procedural volume and patient outcomes for percutaneous coronary interventions: a systematic review and meta-analysis. HRB Open Res 2021; 4:10. [PMID: 33842830 PMCID: PMC8008355 DOI: 10.12688/hrbopenres.13203.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The relationship between procedural volume and outcomes for percutaneous coronary interventions (PCI) is contentious, with previous reviews suggesting an inverse volume-outcome relationship. The aim of this study was to systematically review contemporary evidence to re-examine this relationship. METHODS A systematic review and meta-analysis was undertaken to examine the relationship between PCI procedural volume (both at hospital- and operator-levels) and outcomes in adults. The primary outcome was mortality. The secondary outcomes were complications, healthcare utilisation and process outcomes. Searches were conducted from 1 January 2008 to 28 May 2019. Certainty of the evidence was assessed using 'Grading of Recommendations, Assessment, Development and Evaluations' (GRADE). Screening, data extraction, quality appraisal and GRADE assessments were conducted independently by two reviewers. RESULTS Of 1,154 unique records retrieved, 22 observational studies with 6,432,265 patients were included. No significant association was found between total PCI hospital volume and mortality (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.69-1.03, I 2 = 86%). A temporal trend from significant to non-significant pooled effect estimates was observed. The pooled effect estimate for mortality was found to be significantly in favour of high-volume operators for total PCI procedures (OR: 0.77, 95% CI: 0.63-0.94, I 2 = 93%), and for high-volume hospitals for primary PCI procedures (OR: 0.77, 95% CI: 0.62-0.94, I 2 = 78%). Overall, GRADE certainty of evidence was 'very low'. There were mixed findings for secondary outcomes. CONCLUSIONS A volume-outcome relationship may exist in certain situations, although this relationship appears to be attenuating with time, and there is 'very low' certainty of evidence. While volume might be important, it should not be the only standard used to define an acceptable PCI service and a broader evaluation of quality metrics should be considered that encompass patient experience and clinical outcomes. Systematic review registration: PROSPERO, CRD42019125288.
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Affiliation(s)
- Kieran A. Walsh
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Thomas Plunkett
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Kirsty K. O'Brien
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Conor Teljeur
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Susan M. Smith
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Patricia Harrington
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
| | - Máirín Ryan
- Health Technology Assessment (HTA) Directorate, Health Information and Quality Authority, Dublin 7, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin 8, Ireland
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19
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Kaneko H, Itoh H, Yotsumoto H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Impact of hospital volume on clinical outcomes of hospitalized heart failure patients: analysis of a nationwide database including 447,818 patients with heart failure. BMC Cardiovasc Disord 2021; 21:49. [PMID: 33494701 PMCID: PMC7836495 DOI: 10.1186/s12872-021-01863-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital volume is known to be associated with outcomes of patients requiring complicated medical care. However, the relationship between hospital volume and prognosis of hospitalized patients with heart failure (HF) remains not fully understood. We aimed to clarify the impact of hospital volume on clinical outcomes of hospitalized HF patients using a nationwide inpatient database. METHODS AND RESULTS We studied 447,818 hospitalized HF patients who were admitted from January 2010 and discharged until March 2018 included in the Japanese Diagnosis Procedure Combination database. According to the number of patients, patients were categorized into three groups; those treated in low-, medium-, and high-volume centers. The median age was 81 years and 238,192 patients (53%) were men. Patients who had New York Heart Association class IV symptom and requiring inotropic agent within two days were more common in high volume centers than in low volume centers. Respiratory support, hemodialysis, and intra-aortic balloon pumping were more frequently performed in high volume centers. As a result, length of hospital stay was shorter, and in-hospital mortality was lower in high volume centers. Lower in-hospital mortality was associated with higher hospital volume. Multivariable logistic regression analysis fitted with generalized estimating equation indicated that medium-volume group (Odds ratio 0.91, p = 0.035) and high-volume group (Odds ratio 0.86, p = 0.004) had lower in-hospital mortality compared to the low-volume group. Subgroup analysis showed that this association between hospital volume and in-hospital mortality among overall population was seen in all subgroups according to age, presence of chronic renal failure, and New York Heart Association class. CONCLUSION Hospital volume was independently associated with ameliorated clinical outcomes of hospitalized patients with HF.
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Affiliation(s)
- Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Yotsumoto
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Kiriyama
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Kamon
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- The Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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20
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Moghaddam N, van Diepen S, So D, Lawler PR, Fordyce CB. Cardiogenic shock teams and centres: a contemporary review of multidisciplinary care for cardiogenic shock. ESC Heart Fail 2021; 8:988-998. [PMID: 33452763 PMCID: PMC8006679 DOI: 10.1002/ehf2.13180] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiogenic shock (CS) portends high morbidity and mortality in the contemporary era. Despite advances in temporary mechanical circulatory supports (MCS), their routine use in CS to improve outcomes has not been established. Delays in diagnosis and timely delivery of care, disparities in accessing adjunct therapies such revascularization or MCS, and lack of a systematic approach to care of CS contribute to the poor outcomes observed in CS patients. There is growing interest for developing a standardized multidisciplinary team-based approach in the management of CS. Recent prospective studies have shown feasibility of CS teams in improving survival across a spectrum of CS presentations. Herein, we will review the rationale for CS teams focusing on evidence supporting its use in streamlining care, optimizing revascularization strategies, and patient identification and MCS selection. The proposed structure and flow of CS teams will be outlined. An in-depth analysis of four recent studies demonstrating improved outcomes with CS teams is presented. Finally, we will explore potential implementation hurdles and future directions in refining and widespread implementation of dedicated cross-specialty CS teams.
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Affiliation(s)
- Nima Moghaddam
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean van Diepen
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Derek So
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Lee S, Jang EJ, Jo J, Jang D, Kim BR, Ryu HG. Effect of institutional case volume on mid-term mortality after coronary artery bypass grafting surgery. Gen Thorac Cardiovasc Surg 2021; 69:1275-1282. [PMID: 33428084 DOI: 10.1007/s11748-020-01578-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/18/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The impact of center case volume on mid-term postoperative outcome after coronary artery bypass grafting surgery (CABG) is still controversial and requires investigation. The aim of this study was to compare mid-term survival after CABG according to the institutional annual CABG case volume. METHODS Adult patients (≥ 18 years) who underwent CABG from 2009 to 2016 were identified by searching National Health Insurance database of Korea for CABG procedure codes. Hospitals were classified into three groups based on annual case volume; low-volume centers (< 20 cases/year), medium-volume centers (20-50 cases/year), and high-volume centers (> 50 cases/year). RESULTS A total of 22,575 CABG were performed in 95 centers during the study period, and 14,697 (65.1%) cases performed at 15 high-volume centers, 5,262 (23.3%) cases at 26 medium-volume centers, and 2,616 (11.6%) cases at 54 low-volume centers. The overall 1-year mortality rate was the lowest in high-volume centers (6.5%), followed by medium-volume centers (10.6%) and low-volume centers (15.2%). Logistic regression identified medium-volume centers (adjusted OR 1.30 [95% CI 1.15-1.49], P < 0.01) and low-volume centers (adjusted OR 1.75 [95% CI 1.51-2.03], P < 0.01) as risk factors for 1-year mortality after CABG compared to high-volume centers. In the Cox proportional hazard model, low- and medium-volume centers were significantly risk factors for poor survival (adjusted HR 1.41 [95% CI 1.31-1.54], P < 0.01 and HR 1.26 [95% CI 1.17-1.35], P < 0.01 for low- and medium-volume centers, respectively). CONCLUSIONS Higher institutional case volume of CABG was associated with lower mid-term mortality.
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Affiliation(s)
- Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, 1375 Gyeongdong-Ro, Andong, 36729, Republic of Korea
| | - Junwoo Jo
- Department of Statistics, Kyungpook National University, 80 Daehak-Ro, Daegu, 41566, Republic of Korea
| | - Dongyeon Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Bo Rim Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Ho Geol Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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22
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Meyers DJ, Wilson IB, Lee Y, Rahman M. Understanding the Relationship Between Nursing Home Experience With Human Immunodeficiency Virus and Patient Outcomes. Med Care 2021; 59:46-52. [PMID: 33027238 PMCID: PMC7736101 DOI: 10.1097/mlr.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the population with human immunodeficiency virus (HIV) continues to age, the need for nursing home (NH) care is increasing. OBJECTIVES To assess whether NH's experience in treating HIV is related to outcomes. RESEARCH DESIGN We used claims and assessment data to identify individuals with and without HIV who were admitted to NHs in 9 high HIV prevalent states. We classified NHs into HIV experience categories and estimate the effects of NH HIV experience on patient's outcomes. We applied an instrumental variable using distances between each individual's residence and NHs with different HIV experience. SUBJECTS In all, 5,929,376 admissions for those without HIV and 53,476 admissions for residents with HIV. MEASURES Our primary outcomes were 30-day hospital readmissions, likelihood of becoming a long stay resident, and 180-day mortality posthospital discharge. RESULTS Residents with HIV tended to have poorer outcomes than residents without HIV, regardless of the NH they were admitted to. Residents with HIV admitted to high HIV experience NHs were more likely to be readmitted to the hospital than those admitted to NHs with lower HIV experience (19.6% in 0% HIV NHs, 18.7% in 05% HIV NHs and 22.9% in 5%-50% HIV NHs). CONCLUSIONS Residents with HIV experience worse outcomes in NHs than residents without HIV. Increased HIV experience was not related to improved outcomes.
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Affiliation(s)
- David J Meyers
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
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23
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Samsky MD, Krucoff MW, Morrow DA, Abraham WT, Aguel F, Althouse AD, Chen E, Cigarroa JE, DeVore AD, Farb A, Gilchrist IC, Henry TD, Hochman JS, Kapur NK, Morrow V, Ohman EM, O'Neill WW, Piña IL, Proudfoot AG, Sapirstein JS, Seltzer JH, Senatore F, Shinnar M, Simonton CA, Tehrani BN, Thiele H, Truesdell AG, Waksman R, Rao SV. Cardiac safety research consortium "shock II" think tank report: Advancing practical approaches to generating evidence for the treatment of cardiogenic shock. Am Heart J 2020; 230:93-97. [PMID: 33011148 DOI: 10.1016/j.ahj.2020.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
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24
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Kelham M, Jones TN, Rathod KS, Guttmann O, Proudfoot A, Rees P, Knight CJ, Ozkor M, Wragg A, Jain A, Baumbach A, Mathur A, Jones DA. An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA). EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:S67-S73. [PMID: 33241716 DOI: 10.1177/2048872620974606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre. This study aimed to compare the short-term mortality of patients admitted with an OHCA before-and-after the merger of services had taken place and admission criteria were relaxed, which led to managing OHCA in higher volume. METHODS We retrospectively analysed the data of OHCA patients pre- and post-merger. Baseline demographic and medical characteristics were recorded, along with factors relating to the cardiac arrest. The primary endpoint was in-hospital mortality. RESULTS OHCA patients (N =728; 267 pre- and 461 post-merger) between 2013 and 2018 were analysed. Patients admitted pre-merger were older (65.0 vs. 62.4 years, p=0.027), otherwise there were similar baseline demographic and peri-arrest characteristics. There was a greater proportion of non-acute coronary syndrome-related OHCA admission post-merger (10.1% vs. 23.4%, p=0.0001) and a corresponding decrease in those admitted with ST-elevation myocardial infarction (80.2% vs. 57.0%, p=0.0001) and those treated with percutaneous coronary intervention (78.8% vs. 54.0%, p=0.0001). Despite this, in-hospital mortality was lower post-merger (63.7% vs. 44.3%, p=0.0001), which persisted after adjustment for demographic and arrest-related characteristics using stepwise logistic regression (p=0.036) between the groups. CONCLUSION Despite an increase in non-acute coronary syndrome-related OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit of a cardiac arrest centre model of care.
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Affiliation(s)
- Matthew Kelham
- Barts Interventional Group, Barts Heart Centre, London, UK
| | | | - Krishnaraj S Rathod
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Oliver Guttmann
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | | | - Paul Rees
- Barts Interventional Group, Barts Heart Centre, London, UK
| | | | - Muhiddin Ozkor
- Barts Interventional Group, Barts Heart Centre, London, UK
| | - Andrew Wragg
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Ajay Jain
- Barts Interventional Group, Barts Heart Centre, London, UK
| | - Andreas Baumbach
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Anthony Mathur
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Daniel A Jones
- Barts Interventional Group, Barts Heart Centre, London, UK.,Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
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25
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Kim BK, Nah DY, Choi KU, Bae JH, Rhee MY, Jang JS, Moon KW, Lee JH, Kim HY, Kang SH, Song WH, Lee SU, Shim BJ, Chung H, Hyon MS. Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2020; 50:1026-1036. [PMID: 33118336 PMCID: PMC7596209 DOI: 10.4070/kcj.2020.0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/21/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. METHODS We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. RESULTS Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. CONCLUSIONS Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.
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Affiliation(s)
- Byong Kyu Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Deuk Young Nah
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea.
| | - Kang Un Choi
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jun Ho Bae
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Moo Yong Rhee
- Department of Internal Medicine, Cardiovascular Center, Dongguk University Illsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jae Sik Jang
- Division of Cardiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keon Woong Moon
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jun Hee Lee
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hee Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Seung Ho Kang
- Division of Cardiology, Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea
| | - Woo Hyuk Song
- Department of Cardiology, Korea University Ansan Hospital, Ansan, Korea
| | - Seung Uk Lee
- Division of Cardiology, Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Byung Ju Shim
- Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Korea
| | - Hangjae Chung
- Division of Cardiology, Department of Internal Medicine, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Min Su Hyon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
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Yamaji K, Kohsaka S, Inohara T, Numasawa Y, Ishii H, Amano T, Ikari Y. Population Density Analysis of Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction in Japan. J Am Heart Assoc 2020; 9:e016952. [PMID: 32720569 PMCID: PMC7792283 DOI: 10.1161/jaha.120.016952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Despite recent progress in the treatment of ST‐segment–elevation myocardial infarction, data on geographic disparities application of the evidence‐based therapy remain limited. Methods and Results The J‐PCI (Japanese Percutaneous Coronary Intervention) registry is a nationwide registry to assure the quality of delivered care. Between January 2014 and December 2018, 209 521 patients underwent percutaneous coronary intervention for ST‐segment–elevation myocardial infarction in 1126 institutions. The patients were divided into tertiles according to the population density (PD) of the percutaneous coronary intervention institution location (low: <951.7/km2, n = 69 797; medium: 951.7–4729.7/km2, n = 69 750; high: ≥4729.7/km2, n = 69 974). Patients treated in high PD administrative districts were younger and more likely to be male. No significant correlation was observed between PD and door‐to‐balloon time (regression coefficients: 0.036 per 1000 people/km2; 95% CI, −0.232 to 0.304; P = 0.79). Patients treated in low‐PD areas had higher crude in‐hospital mortality rates than those treated in high‐PD areas (low: 2.89%; medium: 2.60%; high: 2.38%; P < 0.001); PD and in‐hospital mortality had a significantly inverse association, before and after adjusting for baseline characteristics (crude odds ratio [OR], 0.983 per 1000/km2; 95% CI, 0.973–0.992; P < 0.001; adjusted OR, 0.980 per 1000/km2; 95% CI, 0.964–0.996; P = 0.01, respectively). Higher‐PD districts had more operators per institution (low: 6; interquartile range, 3–10; medium: 7; IQR, 3–13; high: 8; IQR, 5–13; P < 0.001), suggesting an inverse association with in‐hospital mortality (OR, 0.992; 95% CI, 0.986–0.999; P = 0.03). Conclusions Geographic inequality was observed in in‐hospital mortality of patients with ST‐segment–elevation myocardial infarction who underwent percutaneous coronary intervention. Variation in the number of operators per institution, rather than traditional quality indicators (eg, door‐to‐balloon time) might explain the difference in in‐hospital mortality.
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Affiliation(s)
- Kyohei Yamaji
- Division of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Shun Kohsaka
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Taku Inohara
- Department of Cardiology Keio University School of Medicine Tokyo Japan.,Division of Cardiology Vancouver General Hospital British Columbia Canada
| | - Yohei Numasawa
- Department of Cardiology Japanese Red Cross Ashikaga Hospital Ashikaga Japan
| | - Hideki Ishii
- Department of Cardiology Fujita Health University Bantane Hospital Nagoya Japan
| | - Tetsuya Amano
- Department of Cardiology Aichi Medical University Aichi Japan
| | - Yuji Ikari
- Department of Cardiology Tokai University School of Medicine Kanagawa Japan
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27
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 4036] [Impact Index Per Article: 1009.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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The Relation between Volume and Outcome of Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Cardiovasc Ther 2020; 2020:2601340. [PMID: 32395180 PMCID: PMC7189304 DOI: 10.1155/2020/2601340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/25/2020] [Accepted: 03/12/2020] [Indexed: 12/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are standard procedures for dealing with severe aortic stenosis patients. Researchers have not carried out a systematic review of the volume-outcome relationship in TAVR and SAVR. Our study is intended to address this problem. We systemically searched databases through MEDLINE, EMBASE, PUBMED, and the Cochrane Library up to September 2019. Two reviewers independently screened for the studies and evaluated bias. We used short-term mortality (in-hospital or 30-day mortality) as an outcome. A meta-analysis of TAVR with 115,596 patients ranging from 2005 to 2016 showed a result significantly in favor of high-volume hospitals (OR 0.43 (CI 0.36-0.51)). The subgroup of population period, region, data type, and cut-off value did not show any difference. A meta-analysis of SAVR comprising 418,384 patients ranging from 1994 to 2011 revealed that the OR of short-term mortality for a high-volume hospital compared with that of a low-volume hospital was 0.73 (CI 0.71, 0.74). No difference was observed in subgroups based on population period and cut-off. In conclusion, we found that short-term mortality was lower in high-volume hospitals for both TAVR and SAVR.
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Aikawa T, Yamaji K, Nagai T, Kohsaka S, Kamiya K, Omote K, Inohara T, Numasawa Y, Tsujita K, Amano T, Ikari Y, Anzai T. Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease -Report From the National Clinical Data (J-PCI Registry). J Am Heart Assoc 2020; 9:e015404. [PMID: 32347146 PMCID: PMC7428587 DOI: 10.1161/jaha.119.015404] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 01/03/2023]
Abstract
Background There is a limited evidence base to support the volume-outcome relationship in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (UPLMD). This study aimed to evaluate the relationship between institutional and operator volume and in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. Methods and Results We analyzed characteristics and clinical outcomes of 24 320 patients undergoing PCI for unprotected left main coronary artery disease at 1102 hospitals by 7244 operators using data from the Japanese nationwide J-PCI Registry (National PCI Data Registry) between January 2014 and December 2017. We classified institutions and operators into quartiles based on the mean annual volume of PCI. A generalized linear mixed-effects model was used to evaluate the association between institutional and operator PCI volume and in-hospital outcomes. Among the 24 320 patients, 4027 (16.6%), 6147 (25.3%), and 14 146 (58.2%) presented with ST-segment-elevation myocardial infarction, non-ST-segment-elevation acute coronary syndrome, and stable ischemic heart disease; their crude in-hospital mortality was 15%, 3.1%, and 0.3%, respectively. Compared with patients in the lowest quartile of institutional volume (1-216 PCIs/y), the adjusted odds ratio of in-hospital death in patients in the second (217-323 PCIs/y), third (324-487 PCIs/y), and fourth (488-3015 PCIs/y) quartile of institutional volume was 0.75 (95% CI, 0.51-1.10; P=0.14), 0.87 (95% CI, 0.57-1.34; P=0.54), and 0.51 (95% CI, 0.30-0.86; P=0.01), respectively. These findings were consistent in rates of in-hospital death or any complication. Conversely, operator PCI volume was not significantly associated with in-hospital outcomes. Conclusions Institutional rather than operator-based PCI volume was associated with better in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease.
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Affiliation(s)
- Tadao Aikawa
- Cardiovascular Research CenterIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Kyohei Yamaji
- Japanese Association of Cardiovascular Intervention and TherapeuticsTokyoJapan
| | - Toshiyuki Nagai
- Department of Cardiovascular MedicineFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Shun Kohsaka
- Japanese Association of Cardiovascular Intervention and TherapeuticsTokyoJapan
| | - Kiwamu Kamiya
- Department of Cardiovascular MedicineFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Kazunori Omote
- Department of Cardiovascular MedicineFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Taku Inohara
- Japanese Association of Cardiovascular Intervention and TherapeuticsTokyoJapan
| | - Yohei Numasawa
- Japanese Association of Cardiovascular Intervention and TherapeuticsTokyoJapan
| | - Kenichi Tsujita
- Japanese Association of Cardiovascular Intervention and TherapeuticsTokyoJapan
| | - Tetsuya Amano
- Japanese Association of Cardiovascular Intervention and TherapeuticsTokyoJapan
| | - Yuji Ikari
- Japanese Association of Cardiovascular Intervention and TherapeuticsTokyoJapan
| | - Toshihisa Anzai
- Department of Cardiovascular MedicineFaculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
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Asaithambi G, Tong X, Lakshminarayan K, Coleman King SM, George MG. Trends in hospital procedure volumes for intra-arterial treatment of acute ischemic stroke: results from the paul coverdell national acute stroke program. J Neurointerv Surg 2020; 12:1076-1079. [PMID: 32169931 DOI: 10.1136/neurintsurg-2020-015844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rates of intra-arterial revascularization treatments (IAT) for acute ischemic stroke (AIS) are increasing in the USA. Using a multi-state stroke registry, we studied the trend in IAT use among patients with AIS over a period spanning 11 years. We examined the impact of IAT rates on hospital procedure volumes and patient outcome after stroke. METHODS We used data from the Paul Coverdell National Acute Stroke Program (PCNASP) and explored trends in IAT between 2008 and 2018. Patient outcomes were examined by rates of IAT procedures across hospitals. Specifically, outcomes were compared across low-volume (<15 IAT per year), medium-volume (15-30 IAT per year), and high-volume hospitals (>30 IAT per year). Favorable outcome was defined as discharge to home. RESULTS There were 612 958 patients admitted with AIS to 687 participating hospitals within the PCNASP during this study. Only 2.9% of patients (mean age 68.5 years, 49.3% women) received IAT. The percent of patients with AIS receiving IAT increased from 1% in 2008 to 5.3% in 2018 (p<0.001). The proportion of low-volume hospitals decreased over time (p<0.001), and the proportions of medium-volume (p=0.007) and high-volume hospitals (p<0.001) increased between 2008 and 2018. When compared with medium-volume hospitals, high-volume hospitals had a higher (p<0.0001) and low-volume hospitals had a lower (p<0.0001) percent of patients discharged to home. CONCLUSION High-volume hospitals were associated with a higher rate of favorable outcome. With the increased use of IAT among patients with AIS, the proportion of low-volume hospitals performing IAT significantly decreased.
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Affiliation(s)
| | - Xin Tong
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Mary G George
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Tie HT, Shi R, Zhou Q, Wang K, Zheng XQ, Wu QC. Annual case volume on mortality after coronary artery bypass grafting: a dose-response meta-analysis. Interact Cardiovasc Thorac Surg 2020; 29:568-575. [PMID: 31230080 DOI: 10.1093/icvts/ivz151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study evaluated the effect of both hospital and surgeon annual case volumes on patient mortality following coronary artery bypass grafting (CABG). METHODS PubMed and Embase databases were searched for clinical studies on CABG. The outcome was mortality, including operative mortality, in-hospital mortality and 30-day mortality. RESULTS Twenty-five studies involving 3 492 101 participants and 143 951 deaths were included for hospital volume, and 4 studies involving 108 356 participants and 2811 deaths were included for surgeon volume. The pooled estimate revealed that both hospital and surgeon annual case volumes were inversely associated with mortality in patients after CABG [odds ratio (OR) for hospital: 0.62, 95% confidence interval (CI) 0.56-0.69; P < 0.001; OR for surgeon: 0.51, 95% CI 0.31- 0.83; P < 0.001] with high heterogeneity (hospital: I2 = 90.6%, Pheterogeneity < 0.001; surgeon: I2 = 86.8%, Pheterogeneity < 0.001). The relationship remained consistent and robust in most subgroup and sensitivity analyses. Our meta-regression analysis of time suggested that the strength of the negative associations between volume and mortality for both hospitals and surgeons remained unattenuated over time even though the CABG mortality gradually decreased over time. The dose-response analysis suggested a non-linear relationship between both hospital and surgeon annual case volumes and mortality (both Pnon-linearity = 0.001). CONCLUSIONS Both higher hospital and surgeon annual case volumes are associated with lower mortality in patients undergoing CABG, and the negative associations remain unattenuated over time. CLINICAL REGISTRATION NUMBER The study was registered at PROSPERO as CRD42017067912.
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Affiliation(s)
- Hong-Tao Tie
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Shi
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Zhou
- Department of Science and Education, The First People's Hospital of Changde City, Hunan, China
| | - Kang Wang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Qing Zheng
- Department of Chemical Biology, School of Pharmaceutical Science, Peking University Health Science Center, Beijing, China
| | - Qing-Chen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Effect of Institutional Case Volume on In-hospital Mortality After Living Donor Liver Transplantation: Analysis of 7073 Cases Between 2007 and 2016 in Korea. Transplantation 2019; 103:952-958. [PMID: 30086090 DOI: 10.1097/tp.0000000000002394] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relationship between institutional case volume and clinical outcomes after living donor liver transplantation is not clarified. METHODS We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 7073 adult living donor liver transplantations were performed at 50 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >50, 10 to 50, and <10. RESULTS In-hospital mortality rates in the high-, medium-, and low-volume centers were 2.8%, 4.1%, and 6.7%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio, 2.287; 95% confidence interval, 1.471-3.557; P < 0.001) and medium-volume centers (adjusted odds ratio, 1.676; 95% confidence interval, 1.089-2.578; P = 0.019) compared with high-volume centers. Long-term survival for up to 9 years was better, and intensive care unit and hospital length of stay were shorter in high-volume centers. CONCLUSIONS Centers with higher case volume (>50 liver transplantations/year) had better outcomes after living donor liver transplantation, including in-hospital mortality and long-term mortality compared with centers with lower case volume (≤50 liver transplantations/year).
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Tsukamoto S, Mavrogenis AF, Tanzi P, Leone G, Akahane M, Tanaka Y, Errani C. Curettage as first surgery for bone giant cell tumor : adequate surgery is more important than oncology training or surgical management by high volume specialized teams. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:3-9. [PMID: 31520122 DOI: 10.1007/s00590-019-02535-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 08/22/2019] [Indexed: 12/14/2022]
Abstract
We reviewed the files of 203 patients with extremities GCTB treated with curettage as first surgery from 1990 to 2013. Median follow-up was 84.2 months. We evaluated whether the years of practice and training in orthopaedic oncology are associated with local recurrences, function and complications after curettage as first surgery for giant cell tumour of bone (GCTB). Local recurrences were not significantly different between orthopaedic oncology trained and non-trained orthopaedic surgeons and between orthopaedic surgeons with < 10 years and ≥ 10 years of practice. Function was not significantly different between orthopaedic oncology trained and non-trained surgeons and between orthopaedic surgeons with < 10 years and ≥ 10 years of practice. The only important univariate and multivariate predictor for local recurrence was PMMA adjuvant. Complications were not significantly different between orthopaedic oncology trained and non-trained orthopaedic surgeons and between orthopaedic surgeons with < 10 years and ≥ 10 years of practice. Curettage may be effectively performed as first surgery for GCTB by early-career (< 10 years of practice) non-trained orthopaedic oncology orthopaedic surgeons. PMMA adjuvant is recommended after appropriate curettage.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Str., 15562, Athens, Greece
| | - Piergiuseppe Tanzi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40136, Bologna, Italy
| | - Giulio Leone
- Department of Orthopaedic Surgery, San Gerardo Hospital, Monza, Italy
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40136, Bologna, Italy.
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Guedeney P, Montalescot G. Interventional Standby for CABG Surgery: The Reverse Paradigm. J Am Coll Cardiol 2019; 73:424-426. [PMID: 30704574 DOI: 10.1016/j.jacc.2018.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Paul Guedeney
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France.
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
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A Long-Forgotten Tale: The Management of Cardiogenic Shock in Acute Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2018-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) present one of the highest mortality rates recorded in critical care. Mortality rate in this setting is reported around 45-50% even in the most experienced and well-equipped medical centers. The continuous development of ST-segment elevation acute myocardial infarction (STEMI) networks has led not only to a dramatic decrease in STEMI-related mortality, but also to an increase in the frequency of severely complicated cases who survive to be transferred to tertiary centers for life-saving treatments. The reduced effectiveness of vasoactive drugs on a severely altered hemodynamic status led to the development of new devices dedicated to advanced cardiac support. What’s more, efforts are being made to reduce time from first medical contact to initiation of mechanical support in this particular clinical context. This review aims to summarize the most recent advances in mechanical support devices, in the setting of CS-complicated AMI. At the same time, the review presents several modern concepts in the organization of complex CS centers. These specialized hubs could improve survival in this critical condition.
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Wu XD, Liu MM, Sun YY, Zhao ZH, Zhou Q, Kwong JSW, Xu W, Tian M, He Y, Huang W. Relationship between hospital or surgeon volume and outcomes in joint arthroplasty: protocol for a suite of systematic reviews and dose-response meta-analyses. BMJ Open 2018; 8:e022797. [PMID: 30552256 PMCID: PMC6303624 DOI: 10.1136/bmjopen-2018-022797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/11/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Joint arthroplasty is a particularly complex orthopaedic surgical procedure performed on joints, including the hip, knee, shoulder, ankle, elbow, wrist and even digit joints. Increasing evidence from volume-outcomes research supports the finding that patients undergoing joint arthroplasty in high-volume hospitals or by high-volume surgeons achieve better outcomes, and minimum case load requirements have been established in some areas. However, the relationships between hospital/surgeon volume and outcomes in patients undergoing arthroplasty are not fully understood. Furthermore, whether elective arthroplasty should be restricted to high-volume hospitals or surgeons remains in dispute, and little is known regarding where the thresholds should be set for different types of joint arthroplasties. METHODS AND ANALYSES This is a protocol for a suite of systematic reviews and dose-response meta-analyses, which will be amended and updated in conjunction with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Electronic databases, including PubMed and Embase, will be searched for observational studies examining the relationship between the hospital or surgeon volume and clinical outcomes in adult patients undergoing primary or revision of joint arthroplasty. We will use records management software for study selection and a predefined standardised file for data extraction and management. Quality will be assessed using the Newcastle-Ottawa Scale, and the meta-analysis, subgroup analysis and sensitivity analysis will be performed using Stata statistical software. Once the volume-outcome relationships are established, we will examine the potential non-linear relationships between hospital/surgeon volume and outcomes and detect whether thresholds or turning points exist. ETHICS AND DISSEMINATION Ethical approval is not required, because these studies are based on aggregated published data. The results of this suite of systematic reviews and meta-analyses will be submitted to peer-reviewed journals for publication. PROSPERO REGISTRATION NUMBER CRD42017056639.
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Affiliation(s)
- Xiang-Dong Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Evidence-Based Perioperative Medicine 07 Collaboration Group, China
| | - Meng-Meng Liu
- Department of Pathology, Anhui Medical University, Hefei, China
| | - Ya-Ying Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhi-Hu Zhao
- Department of orthopaedic, Tianjin Hospital, Tianjin, China
| | - Quan Zhou
- Department of Science and Education, First People’s Hospital of Changde City, Changde, China
| | - Joey S W Kwong
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Department of Clinical Epidemiology, National Center for Child Health and Development, Tokyo, Japan
| | - Wei Xu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mian Tian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopaedic Surgery, Dianjiang People’s Hospital, Chongqing, China
| | - Yao He
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopaedic Surgery, Banan People’s Hospital of Chongqing, Chongqing, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yuan X, Zhang H, Zheng Z, Rao C, Zhao Y, Wang Y, Krumholz HM, Hu S. Trends in mortality and major complications for patients undergoing coronary artery bypass grafting among Urban Teaching Hospitals in China: 2004 to 2013. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 3:312-318. [PMID: 29044398 DOI: 10.1093/ehjqcco/qcx021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/30/2017] [Indexed: 01/25/2023]
Abstract
Aims Although the number of hospitals performing cardiac surgery has increased rapidly in China, information regarding the trends in coronary artery bypass grafting (CABG) outcomes remains unknown. Methods and results We used data from the Chinese Cardiac Surgery Registry, the largest registry system that accounts for nearly 50% of total annual CABG volume in China, to assess trends of in-hospital mortality and major complication rates for patients receiving isolated CABG in 102 urban teaching hospitals in China from 25 January 2004 through 31 December 2013 (except 2006 and 2009). Using a mixed effects model, we estimated annual trends in each of these two outcomes overall and by age groups (18-64 and 65 years or older), adjusted for patient characteristics. We also assessed the trends in pre-operative, post-operative, and total length of stay (LOS). The study included 40 652 patients across 102 hospitals. Between 2004 and 2013, patients' mean age decreased from 62.7 to 61.4 years, in-hospital mortality decreased from 2.8% to 1.6% (difference, 1.3%, 95% CI: 0.70-1.85), and major complication rates decreased from 7.8% to 3.8% (difference, 4.0%; 95% CI: 3.05-4.90). The reduction in mortality and major complication rates were consistent across age groups. Between 2004 and 2013, the median (inter-quartile range) pre-operative LOS remained unchanged, post-operative LOS declined from 12.0 (8.0) to 10.0 (7.0) days, and total LOS declined from 22.0 (13.0) to 20.0 (12.0) days. Conclusion Isolated CABG-related in-hospital mortality, major complication rates, and LOS have improved in urban teaching hospitals in China over the last decade.
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Affiliation(s)
- Xin Yuan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, #167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Heng Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, #167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Zhe Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, #167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Chenfei Rao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, #167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Yan Zhao
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
| | - Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health 655, Huntington Avenue, Boston, Massachusetts, 02115, USA.,The center for Outcomes Research and Evaluation and Yale-New Haven Health, 1 Church Street, Suit 200, New Haven, Cnnecticut 06510, USA
| | - Harlan M Krumholz
- The center for Outcomes Research and Evaluation and Yale-New Haven Health, 1 Church Street, Suit 200, New Haven, Cnnecticut 06510, USA.,Section of Cardiovascular Medicine Yale University School of Medicine, 330 Cedar Street, New Haven, Connecticut 06519, USA.,Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, Connecticut 06510, USA
| | - Shengshou Hu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, 167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, #167, Beilishi Road, Xicheng District, Beijing 100037, People's Republic of China
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Effect of Institutional Case Volume on In-Hospital Mortality After Deceased Donor Liver Transplantation: A Nationwide Retrospective Cohort Study in Korea. Transplant Proc 2018; 50:3644-3649. [DOI: 10.1016/j.transproceed.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 12/25/2022]
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40
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Sarkar K. Heart Team-the Indian perspective. Indian J Thorac Cardiovasc Surg 2018; 34:355-361. [PMID: 33060959 PMCID: PMC7525544 DOI: 10.1007/s12055-018-0764-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The European Society of Cardiology and the European Association for Cardio-Thoracic Surgery as well as the American College of Cardiology and the American Heart association have recognized the "Heart Team" as the best option for a patient centric treatment strategy and has granted a class I recommendation for its formation. The aim of this review is to discuss the evolution, scope and composition, the benefits, and problems inherent in its implementation in the Indian scenario. METHODS A review of articles on Heart Team from cardiac surgery as well as multidisciplinary meetings from other specialties was performed. Advantages of Heart Team formation and its implementation have been critically evaluated and its applicability to the Indian scenario considered in particular. RESULTS Heart Team formation is associated with many positives. Concern remains about the implementation of Heart Team approach in its true sense. Heart Team-led decisions are definitely patient centric despite multiple challenges in resource-limited environments. CONCLUSIONS Despite the challenges, a multidisciplinary team approach in the form of Heart Team is recommended and its implementation possible in India. However, adjustments to the mechanism of implementation are required. Further research needs to focus on creating models for implementation and assessment of these models in terms of cost effectiveness, improved patient outcomes, and patient satisfaction in the process.
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Affiliation(s)
- Kunal Sarkar
- Department of Cardiac Surgery, Medica Superspecialty Hospital, Kolkata, India
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41
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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42
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Shah R, Askari R, Haji SA, Rashid A. Mortality and operator experience with vascular access for percutaneous coronary intervention in patients with acute coronary syndromes: A pairwise and network meta-analysis of randomized controlled trials. Int J Cardiol 2018; 248:114-119. [PMID: 28942869 DOI: 10.1016/j.ijcard.2017.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/27/2017] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, several meta-analyses of randomized controlled trials (RCTs) have shown that transradial access (TRA) reduces mortality compared to transfemoral access (TFA). However, a critical appraisal of these RCTs suggests that the findings could have resulted from a greater incidence of adverse events in the TFA groups rather than a beneficial effect of TRA. METHODS Scientific databases and websites were searched for RCTs. Patients were divided into groups based on access type and whether the operator was a radial expert (RE) or non-radial expert (NRE). The groups were TFA-RE, TFA-NRE, TRA-RE, and TRA-NRE. Both a traditional meta-analysis and a network meta-analysis using mixed-treatment comparison models were performed. RESULTS Data from 13 trials including 15,615 patients were analyzed. The mortality rate for TFA-RE (3.54%) was more than double compared to TFA-NRE (1.61%). In pairwise meta-analysis, TFA-RE was associated with increased risk of mortality (RR: 1.72, 95% CI: 1.13-2.62; p=0.011) compared to TFA-NRE. In subgroup analysis, TFA-RE was associated with increased mortality (RR: 1.70, 95% CI: 1.24-2.34; p=0.001) compared to TRA, but TRA-NRE was not. Similarly, in mixed comparison models, TFA-RE was associated with increased mortality compared to TRA-NRE, TRA-RE, and TFA-NRE, but TFA-NRE was not, compared to TRA-RE and TRA-NRE. CONCLUSION Recently-reported survival differences between TRA and TFA may have been driven by adverse events in the TFA groups of the RCTs rather than a beneficial effect of TRA. This issue needs further investigation before labeling radial access a lifesaving procedure in invasively-managed patients with ACS.
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Affiliation(s)
- Rahman Shah
- Section of Cardiology, University of Tennessee, School of Medicine, Memphis, TN, United States; Veterans Affairs Medical Center, Memphis, TN, United States.
| | - Reza Askari
- Section of Cardiology, University of Tennessee, School of Medicine, Memphis, TN, United States
| | - Showkat A Haji
- Section of Cardiology, University of Tennessee, School of Medicine, Memphis, TN, United States
| | - Abdul Rashid
- Jackson Clinic, University of Tennessee, Jackson, TN, United States
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43
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Venigalla S, Nead KT, Sebro R, Guttmann DM, Sharma S, Simone CB, Levin WP, Wilson RJ, Weber KL, Shabason JE. Association Between Treatment at High-Volume Facilities and Improved Overall Survival in Soft Tissue Sarcomas. Int J Radiat Oncol Biol Phys 2018; 100:1004-1015. [PMID: 29485042 PMCID: PMC5830163 DOI: 10.1016/j.ijrobp.2017.12.262] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Soft tissue sarcomas (STS) are rare malignancies that require complex multidisciplinary management. Therefore, facilities with high sarcoma case volume may demonstrate superior outcomes. We hypothesized that STS treatment at high-volume (HV) facilities would be associated with improved overall survival (OS). METHODS AND MATERIALS Patients aged ≥18 years with nonmetastatic STS treated with surgery and radiation therapy at a single facility from 2004 through 2013 were identified from the National Cancer Database. Facilities were dichotomized into HV and low-volume (LV) cohorts based on total case volume over the study period. OS was assessed using multivariable Cox regression with propensity score-matching. Patterns of care were assessed using multivariable logistic regression analysis. RESULTS Of 9025 total patients, 1578 (17%) and 7447 (83%) were treated at HV and LV facilities, respectively. On multivariable analysis, high educational attainment, larger tumor size, higher grade, and negative surgical margins were statistically significantly associated with treatment at HV facilities; conversely, black race and non-metropolitan residence were negative predictors of treatment at HV facilities. On propensity score-matched multivariable analysis, treatment at HV facilities versus LV facilities was associated with improved OS (hazard ratio, 0.87, 95% confidence interval, 0.80-0.95; P = .001). Older age, lack of insurance, greater comorbidity, larger tumor size, higher tumor grade, and positive surgical margins were associated with statistically significantly worse OS. CONCLUSIONS In this observational cohort study using the National Cancer Database, receipt of surgery and radiation therapy at HV facilities was associated with improved OS in patients with STS. Potential sociodemographic disparities limit access to care at HV facilities for certain populations. Our findings highlight the importance of receipt of care at HV facilities for patients with STS and warrant further study into improving access to care at HV facilities.
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Affiliation(s)
- Sriram Venigalla
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Kevin T Nead
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ronnie Sebro
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David M Guttmann
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sonam Sharma
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
| | - William P Levin
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robert J Wilson
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristy L Weber
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacob E Shabason
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Gargiulo G, Heg D, Ferrari F, Percoco G, Campo G, Tumscitz C, Colombo F, Zuffi A, Castriota F, Cremonesi A, Windecker S, Valgimigli M. Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results? J Am Heart Assoc 2017; 6:JAHA.117.007150. [PMID: 29275371 PMCID: PMC5779027 DOI: 10.1161/jaha.117.007150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Operator experience influences outcomes after percutaneous coronary intervention, but this association in the controlled setting of a randomized, clinical trial is unclear. Methods and Results We investigated operator‐related outcomes (30‐day and 2‐year efficacy and safety end points) among patients undergoing percutaneous coronary intervention and randomized to different dual antiplatelet therapy durations and stent types. A total of 2003 patients were analyzed, and 7 operator groups were compared. The majority of preprocedural and postprocedural characteristics were imbalanced. The primary end point of the study, the composite of death, myocardial infarction, or cerebrovascular accidents, did not differ among operators at 30 days or 2 years. There were no significant differences also for all other individual and composite end points analyzed at 30 days and 2 years, except for 2‐year stent thrombosis (P=0.048) and bleeding events (P=0.022 for Bleeding Academic Research Consortium type 2, 3, or 5). Adjusted comparisons for the main end points showed slight differences among operators at 30 days, but not at 2 years. There was no interaction of operator with dual antiplatelet therapy duration (P=0.112) or stent type (P=0.300). Results remained entirely consistent when operators were stratified by their experience. Conclusions There was a weak signal of heterogeneity across study operators for the 30‐day, but not the 2‐year, main study outcomes. No clear effect of operator or operator experience was observed for the comparative efficacy and safety profile of the randomized stent types or dual antiplatelet therapy duration regimens. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00611286.
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Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland.,Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Dik Heg
- Clinical Trial Unit (CTU) Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | | | | | - Gianluca Campo
- Cardiology Unit, University of Ferrara, Cona (FE), Italy
| | - Carlo Tumscitz
- Cardiology Unit, University of Ferrara, Cona (FE), Italy
| | - Federico Colombo
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Zuffi
- Institut Cardiovasculaire de Caen, Hôpital privé Saint Martin, Caen, France
| | | | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
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O'Neill D, Nicholas O, Gale CP, Ludman P, de Belder MA, Timmis A, Fox KAA, Simpson IA, Redwood S, Ray SG. Total Center Percutaneous Coronary Intervention Volume and 30-Day Mortality: A Contemporary National Cohort Study of 427 467 Elective, Urgent, and Emergency Cases. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003186. [PMID: 28320707 DOI: 10.1161/circoutcomes.116.003186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/20/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relationship between procedural volume and prognosis after percutaneous coronary intervention (PCI) remains uncertain, with some studies finding in favor of an inverse association and some against. This UK study provides a contemporary reassessment in one of the few countries in the world with a nationally representative PCI registry. METHODS AND RESULTS A nationwide cohort study was performed using the national British Cardiovascular Intervention Society registry. All adult patients undergoing PCI in 93 English and Welsh NHS hospitals between 2007 and 2013 were analyzed using hierarchical modeling with adjustment for patient risk. Of 427 467 procedures (22.0% primary PCI) in 93 hospitals, 30-day mortality was 1.9% (4.8% primary PCI). 87.1% of centers undertook between 200 and 2000 procedures annually. Case mix varied with center volume. In centers with 200 to 399 PCI cases per year, a smaller proportion were PCI for ST-segment-elevation myocardial infarction (8.4%) than in centers with 1500 to 1999 PCI cases per year (24.2%), but proportionally more were for ST-segment-elevation myocardial infarction with cardiogenic shock (8.4% versus 4.3%). For the overall PCI cohort, after risk adjustment, there was no significant evidence of worse, or better, outcomes in lower volume centers from our own study, or in combination with results from other studies. For primary PCI, there was also no evidence for increased or decreased mortality in lower volume centers. CONCLUSIONS After adjustment for differences in case mix and clinical presentation, this study supports the conclusion of no trend for increased mortality in lower volume centers for PCI in the UK healthcare system. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. Unique identifier: NCT02184949.
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Affiliation(s)
- Darragh O'Neill
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.).
| | - Owen Nicholas
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Chris P Gale
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Peter Ludman
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Mark A de Belder
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Adam Timmis
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Keith A A Fox
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Iain A Simpson
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Simon Redwood
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
| | - Simon G Ray
- From the Research Department of Epidemiology and Public Health, University College London, United Kingdom (D.O., O.N.); Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (C.P.G.); Department of Cardiology, York Teaching Hospital, United Kingdom (C.P.G.); Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, United Kingdom (A.T.); Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.); Wessex Cardiac Unit, University Hospital Southampton, United Kingdom (I.A.S.); King's College London/St Thomas' Hospital, United Kingdom (S.R.); University Hospitals of South Manchester, United Kingdom (S.G.R.)
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Lu TH, Li ST, Liang FW, Lee JC, Yin WH. When high-volume PCI operators in high-volume hospitals move to lower volume hospitals-Do they still maintain high volume and quality of outcomes? Catheter Cardiovasc Interv 2017; 92:644-650. [PMID: 29086474 DOI: 10.1002/ccd.27403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/23/2017] [Accepted: 10/14/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this quasi-experimental study was to examine whether high-volume percutaneous coronary intervention (PCI) operators still maintain high volume and quality of outcomes when they moved to lower volume hospitals. BACKGROUND Systematic reviews have indicated that high-volume PCI operators and hospitals have higher quality outcomes. However, little is known on whether high PCI volume and high quality outcomes are mainly due to operator characteristics (i.e., skill and experience) and is portable across organizations or whether it is due to hospital characteristics (i.e., equipment, team, and management system) and is less portable. METHODS We used Taiwan National Health Insurance claims data 2000-2012 to identify 98 high-volume PCI operators, 10 of whom moved from one hospital to another during the study period. We compared the PCI volume, risk-adjusted mortality ratio, and major adverse cardiovascular event (MACE) ratio before and after moving. RESULTS Of the 10 high-volume operators who moved, 6 moved from high- to moderate- or low-volume hospitals, with median annual PCI volumes (interquartile range) of 130 (117-165) in prior hospitals and 54 (46-84) in subsequent hospitals (the hospital the operator moved to), and the remaining 4 moved from high to high-volume hospitals, with median annual PCI volumes (interquartile range) of 151 (133-162) in prior hospitals and 193 (178-239) in subsequent hospitals. No significant differences were observed in the risk-adjusted mortality ratios and MACE ratios between high-volume operators and matched controls before and after moving. CONCLUSIONS High-volume operators cannot maintain high volume when they moved from high to moderate or low-volume hospitals; however, the quality of care is maintained. High PCI volume and high-quality outcomes are less portable and more hospital bound.
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Affiliation(s)
- Tsung-Hsueh Lu
- Department of Public Health, The NCKU Research Center for Health Data and College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Tun Li
- Department of Industrial and Information Management, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, The NCKU Research Center for Health Data and College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jo-Chi Lee
- Department of Public Health, The NCKU Research Center for Health Data and College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng Hsin General Hospital, and Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
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van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e232-e268. [PMID: 28923988 DOI: 10.1161/cir.0000000000000525] [Citation(s) in RCA: 985] [Impact Index Per Article: 140.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities.
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48
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Early mortality following percutaneous coronary intervention and cardiac surgery: Correlations within providers and operators. Int J Cardiol 2017; 240:97-102. [DOI: 10.1016/j.ijcard.2017.04.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/31/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
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Acharya T, Salisbury AC, Spertus JA, Kennedy KF, Bhullar A, Reddy HKK, Joshi BK, Ambrose JA. In-Hospital Outcomes of Percutaneous Coronary Intervention in America’s Safety Net. JACC Cardiovasc Interv 2017; 10:1475-1485. [DOI: 10.1016/j.jcin.2017.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/15/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
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50
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Tsurumaki Y, Haraguchi Y, Nakamura T. Safety of Radial Access for Primary Percutaneous Intervention in Patients With ST-Elevation Acute Myocardial Infarction: Results From a Low-Volume Center. Angiology 2017; 69:387-392. [PMID: 28737069 DOI: 10.1177/0003319717722282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radial access for primary percutaneous coronary intervention (pPCI) in patients with ST-elevation acute myocardial infarction (STEMI) is recommended in high-volume experienced centers. This study investigated whether radial access for pPCI is safe even in a low-volume center. We performed radial access for pPCI in 171 patients. Major adverse cardiac events (total death, myocardial infarction, stroke) rate was 1.2%. The overall incidence of bleeding complications was 2.4%; there was no vascular complication at the access site. In patients with STEMI undergoing pPCI, the results of radial access in a low-volume center were acceptable. These findings support the safety of radial access in patients with STEMI.
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Affiliation(s)
- Yoshimasa Tsurumaki
- 1 Department of Cardiology, Saitama Citizens Medical Center, Nishi-ku, Saitama-city, Saitama, Japan
| | - Yumiko Haraguchi
- 1 Department of Cardiology, Saitama Citizens Medical Center, Nishi-ku, Saitama-city, Saitama, Japan
| | - Tomohiro Nakamura
- 1 Department of Cardiology, Saitama Citizens Medical Center, Nishi-ku, Saitama-city, Saitama, Japan
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