1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Kodaira M, Kuno T, Numasawa Y, Ohki T, Nakamura I, Ueda I, Fukuda K, Kohsaka S. Differences of in-hospital outcomes within patients undergoing percutaneous coronary intervention at institutions with high versus low procedural volume: a report from the Japanese multicentre percutaneous coronary intervention registry. Open Heart 2018; 5:e000781. [PMID: 30018774 PMCID: PMC6045738 DOI: 10.1136/openhrt-2018-000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/17/2018] [Accepted: 05/29/2018] [Indexed: 02/03/2023] Open
Abstract
Objective We aimed to determine the relationship between the prevalence of in-hospital complications and annual institutional patient volume in a population of patients undergoing percutaneous coronary intervention (PCI). Methods Clinical data of patients receiving PCI between January 2010 and June 2015 were collected from 14 academic institutions in the Tokyo area and subsequently used for analysis. We employed multivariate hierarchical logistic regression models to determine the effect of institutional volume on several in-hospital outcomes, including in-hospital mortality and procedure-related complications. Results A total of 14 437 PCI cases were included and categorised as receiving intervention from either lower-volume (<200 procedures/year, n=6 hospitals) or higher-volume (≥200 procedures/year, n=8 hospitals) institutions. Clinical characteristics differed significantly between the two patient groups. Specifically, patients treated in higher-volume hospitals presented with increased comorbidities and complex coronary lesions. Unadjusted mortality and complication rate in lower-volume and higher-volume hospitals were 1.3% and 1.2% (p=0.0614) and 6.2% and 8.1% (p=0.001), respectively. However, multivariate hierarchical logistic regression models adjusting for differences in the patient characteristics demonstrated that institutional volume was not associated with adverse clinical outcomes. Conclusions In conclusion, we observed no significant association between annual institutional volume and in-hospital outcomes within the contemporary PCI multicentre registry. Trial registration number UMIN R000005598.
Collapse
Affiliation(s)
- Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Takahiro Ohki
- Department of Cardiology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Iwao Nakamura
- Department of Cardiology, Hino Shiritsu Byoin, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
4
|
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.
Collapse
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.)
| |
Collapse
|
5
|
Impact of Institutional and Operator Volume on Short-Term Outcomes of Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2017; 10:918-927. [DOI: 10.1016/j.jcin.2017.02.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022]
|
6
|
Lee PT, Chao TH, Huang YL, Lin SH, Wang WM, Lee WH, Huang CW, Lee CH, Chen JY, Lin CC, Liu PY, Chan SH, Liu YW, Tsai WC, Lin LJ, Tsai LM, Li YH. Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014. Int Heart J 2016; 57:541-6. [PMID: 27581671 DOI: 10.1536/ihj.15-454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death.
Collapse
Affiliation(s)
- Po-Tseng Lee
- Department of Internal Medicine, Institute of Clinical Medicine and Biostatistics Consulting Center, National Cheng Kung University Hospital and College of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Lin X, Tao H, Cai M, Liao A, Cheng Z, Lin H. A Systematic Review and Meta-Analysis of the Relationship Between Hospital Volume and the Outcomes of Percutaneous Coronary Intervention. Medicine (Baltimore) 2016; 95:e2687. [PMID: 26844508 PMCID: PMC4748925 DOI: 10.1097/md.0000000000002687] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous reviews have suggested that hospital volume is inversely related to in-hospital mortality. However, percutaneous coronary intervention (PCI) practices have changed substantially in recent years, and whether this relationship persists remains controversial.A systematic search was performed using PubMed, Embase, and the Cochrane Library to identify studies that describe the effect of hospital volume on the outcomes of PCI. Critical appraisals of the methodological quality and the risk of bias were conducted independently by 2 authors. Fourteen of 96 potentiality relevant articles were included in the analysis. Twelve of the articles described the relationship between hospital volume and mortality and included data regarding odds ratios (ORs); 3 studies described the relationship between hospital volume and long-term survival, and only 1 study included data regarding hazard ratios (HRs). A meta-analysis of postoperative mortality was performed using a random effects model, and the pooled effect estimate was significantly in favor of high volume providers (OR: 0.79; 95% confidence interval [CI], 0.72-0.86; P < 0.001). A systematic review of long-term survival was performed, and a trend toward better long-term survival in high volume hospitals was observed.This meta-analysis only included studies published after 2006 and revealed that postoperative mortality following PCI correlates significantly and inversely with hospital volume. However, the magnitude of the effect of volume on long-term survival is difficult to assess. Additional research is necessary to confirm our findings and to elucidate the mechanism underlying the volume-outcome relationship.
Collapse
Affiliation(s)
- Xiaojun Lin
- From the Department of Health Administration, School of Medicine and Health Management (XL, HT, MC, ZC, HL); and Family Planning Research Institute, Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology (AL), Wuhan, China
| | | | | | | | | | | |
Collapse
|
8
|
Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | |
Collapse
|
9
|
ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. J Am Coll Cardiol 2013; 62:357-96. [DOI: 10.1016/j.jacc.2013.05.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
10
|
Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, Dehmer GJ, Deychak YA, Jneid H, Jollis JG, Landzberg JS, Levine GN, McClurken JB, Messenger JC, Moussa ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, White CJ, Williams ES. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013; 128:436-72. [PMID: 23658439 DOI: 10.1161/cir.0b013e318299cd8a] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
11
|
Nomura T, Keira N, Kojima A, Urakabe Y, Enomoto-Uemura S, Nishikawa S, Naito D, Matsubara H, Tatsumi T. Effects of cardiologist experience on outcomes of patients with ST-elevated myocardial infarction treated with primary PCI in a local area in Japan. Int Heart J 2011; 52:127-30. [PMID: 21646732 DOI: 10.1536/ihj.52.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary percutaneous coronary intervention (PCI) for ST-elevated myocardial infarction (STEMI) results in dramatically improved clinical outcomes when performed in a timely manner. Although guidelines for STEMI patients recommend PCI should be performed by experienced operators with acceptable PCI volume, cardiologists in a local area must perform primary PCI at their own hospitals. This study evaluated the effects of cardiologist experience on outcomes for STEMI patients in a local area in Japan.Between April 2007 and March 2010, 140 consecutive STEMI patients were admitted to our hospital and 121 of these patients received primary PCI. STEMI patients undergoing primary PCI were divided into two groups according to the operator's experience as a cardiologist. We retrospectively analyzed their clinical backgrounds, PCI findings, in-hospital outcomes, and drug administration at discharge.There were no significant differences in any clinical characteristics, angiographic findings, or PCI procedures between the two groups. Clinical outcomes of the two groups were similar, except for the length of hospital stay (21.1 ± 5.8 versus 15.5 ± 9.7; P = 0.0255). The frequency of administration of drugs such as β-blockers (59.1% versus 34.0%; P = 0.0086), aldosterone blockade (10.4% versus 25.5%; P = 0.0334), and nicorandil (76.1% versus 25.5%; P = < 0.0001) was different between the two groups.The clinical outcomes of STEMI patients in this study were satisfactory and almost equivalent when compared according to the experience of the attending cardiologist. The present findings suggest the important clinical implication that younger cardiologists who have experienced PCI procedures to a certain extent can safely perform primary PCI and contribute to better prognoses of STEMI patients.
Collapse
Affiliation(s)
- Tetsuya Nomura
- Department of Cardiovascular Medicine, Nantan General Hospital, Kyoto Prefectural University School of Medicine, Nantan City, Kyoto, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Martin-Gill C, Dilger CP, Guyette FX, Rittenberger JC, Callaway CW. Regional impact of cardiac arrest center criteria on out-of-hospital transportation practices. PREHOSP EMERG CARE 2011; 15:381-7. [PMID: 21463201 DOI: 10.3109/10903127.2011.561409] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cardiac arrest center (CAC) criteria are not well defined, nor is their potential impact on current emergency medical services (EMS) transportation practices for post-cardiac arrest (PCA) patients. In addition to the availability of emergent cardiac catheterization (CATH) and therapeutic hypothermia (TH), high-volume centers and those with PCA protocols have been associated with improved outcomes. Objectives. This study aimed 1) to identify the PCA treatment capabilities of receiving hospitals in a 10-county regional EMS system without official CAC designation and 2) to determine the proportion of PCA patients who are transported to hospitals meeting three proposed CAC definitions. We hypothesized that a majority of patients are already transported to hospitals that meet proposed CAC criteria. METHODS We distributed a survey to 34 receiving hospitals to determine availability and volume of CATH, TH, a PCA protocol, and a 24-hour intensivist. We conducted a retrospective study of adult, nontrauma cardiac arrest patients transported with a pulse from 2006 to 2008 for 16 EMS agencies. The proportions of patients transported to hospitals meeting three CAC criteria were compared: criteria A (availability of CATH and TH), criteria B (criteria A, >200 CATHs per year, and a PCA protocol), and criteria C (criteria B and a 24-hour intensivist). RESULTS Data were obtained from 31 of 34 hospitals (91.1%), of which 10 (32.3%) met criteria A, seven (22.6%) met criteria B, and six (19.4%) met criteria C. Of 1,193 cardiac arrest patients, 46 (3.9%) were excluded because of transport to a pediatric, closed, or out-of-region hospital. There were 335 patients (81.1%) with return of spontaneous circulation and a pulse present upon arrival at the destination facility transported to hospitals meeting criteria A, 304 patients (73.6%) transported to hospitals meeting criteria B, and 273 patients (66.1%) transported to hospitals meeting criteria C. CONCLUSIONS In a region without official CAC designation, only one-third of hospitals meet basic CAC criteria (CATH and TH), but those facilities receive 81% of PCA patients. Fewer patients (66%) are transported to hospitals meeting more stringent CAC criteria. These data describe the potential impact of developing a CAC policy based on current transportation practices.
Collapse
Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
| | | | | | | | | |
Collapse
|
13
|
Kuwabara H, Fushimi K, Matsuda S. Relationship Between Hospital Volume and Outcomes Following Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction. Circ J 2011; 75:1107-12. [DOI: 10.1253/circj.cj-10-0556] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroyo Kuwabara
- Health Care Informatics Section, Department of Health Policy, Tokyo Medical and Dental University Graduate School
| | - Kiyohide Fushimi
- Health Care Informatics Section, Department of Health Policy, Tokyo Medical and Dental University Graduate School
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health School of Medicine, University of Occupational and Environmental Health
| |
Collapse
|
14
|
Dong L, Zhang F, Shu X. Upstream vs deferred administration of small-molecule glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: insights from randomized clinical trials. Circ J 2010; 74:1617-24. [PMID: 20571247 DOI: 10.1253/circj.cj-10-0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent data have demonstrated similar outcomes for patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) and are treated with small-molecule glycoprotein IIb/IIIa inhibitors (smGPIs) compared with those treated with abciximab. In the present study, a meta-analysis was performed to evaluate the relative safety and efficacy of upstream vs deferred administration of smGPIs in STEMI patients. METHODS AND RESULTS A total of 10 randomized clinical trials comparing upstream vs deferred administration of smGPIs in 2,724 patients were located in the electronic databases of the published literature. Preprocedural Thrombolysis In Myocardial Infarction Study (TIMI) grade 2 or 3 flow was present in 45.0% of the upstream group compared with 36.9% in the deferred group (odds ratio (OR) 1.40, P<0.001). However, no difference in post-procedural TIMI 3 flow (OR 0.87, P=0.25) was found between the groups. The 30-day mortality rate in the upstream group did not differ from that of the deferred group (OR 1.04, P=0.85). No significant difference was noted with respect to major bleeding complications (OR 1.25, P=0.38). CONCLUSIONS In STEMI patients scheduled for primary PCI, although early smGPIs treatment improved initial epicardial patency, no beneficial effect on post-procedural angiographic or 30-day clinical outcome was found. Thus, the current available data do not support the routine utilization of upstream smGPIs in STEMI patients treated with primary PCI.
Collapse
Affiliation(s)
- Lili Dong
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | |
Collapse
|
15
|
Post PN, Kuijpers M, Ebels T, Zijlstra F. The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis. Eur Heart J 2010; 31:1985-92. [DOI: 10.1093/eurheartj/ehq151] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
16
|
Shiraishi J, Kohno Y, Sawada T, Takeda M, Arihara M, Hyogo M, Shima T, Okada T, Nakamura T, Matoba S, Yamada H, Matsumuro A, Shirayama T, Kitamura M, Furukawa K, Matsubara H. Predictors of nonoptimal coronary flow after primary percutaneous coronary intervention with stent implantation for acute myocardial infarction. J Cardiol 2010; 55:217-23. [PMID: 20206075 DOI: 10.1016/j.jjcc.2009.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 10/18/2009] [Accepted: 11/02/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Shiraishi J, Kohno Y, Sawada T, Takeda M, Arihara M, Hyogo M, Shima T, Okada T, Nakamura T, Matoba S, Yamada H, Matsumuro A, Shirayama T, Kitamura M, Furukawa K, Matsubara H. Influence of previous myocardial infarction site on in-hospital outcome after primary percutaneous coronary intervention for repeat myocardial infarction. J Cardiol 2010; 55:77-83. [DOI: 10.1016/j.jjcc.2009.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 08/09/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
|
18
|
Shiraishi J, Kohno Y, Sawada T, Kimura M, Ariyoshi M, Matsui A, Takeda M, Arihara M, Hyogo M, Shima T, Okada T, Nakamura T, Matoba S, Yamada H, Matsumuro A, Kitamura M, Furukawa K, Matsubara H, The AMI-Kyoto Multi-Center Risk Study Group. Predictors of In-Hospital Prognosis After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Requiring Mechanical Support Devices. Circ J 2010; 74:1152-7. [DOI: 10.1253/circj.cj-09-0774] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Yoshio Kohno
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takahisa Sawada
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | | | | | - Akihiro Matsui
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Mitsuo Takeda
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Masayasu Arihara
- Department of Emergency Medicine, Kyoto First Red Cross Hospital
| | - Masayuki Hyogo
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takatomo Shima
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takashi Okada
- Department of Cardiology, Kyoto First Red Cross Hospital
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | - Hiroyuki Yamada
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | | | | | | | - Hiroaki Matsubara
- Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine
| | | |
Collapse
|
19
|
Suzuki H, Geshi E, Nanjyo S, Nakano H, Yamazaki J, Sato N, Tanaka K, Takano T, Yagi H, Shibata T, Mochizuki S, Katagiri T. Inhibitory Effect of Valsartan Against Progression of Left Ventricular Dysfunction After Myocardial Infarction. Circ J 2009; 73:918-24. [DOI: 10.1253/circj.cj-08-0959] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Suzuki
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Eiichi Geshi
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| | - Shuji Nanjyo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Omori Hospital, Toho University Omori Medical Center
| | - Hajime Nakano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Omori Hospital, Toho University Omori Medical Center
| | - Jyunichi Yamazaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Omori Hospital, Toho University Omori Medical Center
| | - Naoki Sato
- Department of Internal Medicine (Divisions of Cardiology, Hepatology, Geriatric, and Integrated Medicine), Nippon Medical School
| | - Keiji Tanaka
- Department of Internal Medicine (Divisions of Cardiology, Hepatology, Geriatric, and Integrated Medicine), Nippon Medical School
| | - Teruo Takano
- Intensive & Cardiac Care Unit, Nippon Medical School
| | - Hidenori Yagi
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine
| | - Takahiro Shibata
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine
| | - Seibu Mochizuki
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine
| | - Takashi Katagiri
- Department of Medicine, Division of Cardiology, Showa University School of Medicine
| |
Collapse
|