title: Variation in outcomes after percutaneous coronary intervention in the United States and predictors of periprocedural mortality.
abstract: The objective of this study was to characterize variation in mortality rates across hospitals performing percutaneous coronary intervention (PCI) in the United States. For this purpose, data (n = 735,022) from the Nationwide Inpatient Sample from 1996 to 2001 were analyzed. The primary outcome for the analysis was postprocedural in-hospital mortality. Mortality rates were calculated by race, gender, geographic region, comorbid status and hospital volume. There were significant variations in mortality across gender groups, comorbid status, regions and by hospital volume status. Independent predictors of mortality in this large cohort were older age, female gender, lower income and lower hospital volume. The data suggests targets for quality improvement initiatives for patients undergoing PCI particularly in the elderly, females, lower income patients and low volume hospitals. Even in the contemporary era of adjunctive pharmacological therapies and ubiquitous use of stents, hospital volume remains a significant independent predictor of in-hospital mortality.
authors.affiliation: University of Michigan Cardiovascular Center, Ann Arbor, Mich., USA. Mukherjee@uky.edu
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Reid M
authors.initials: RM
authors.lastname: Wainess
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
authors.forename: John A
authors.initials: JA
authors.lastname: Cowan
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rajagopalan
authors.forename: Stanley
authors.initials: S
authors.lastname: Chetcuti
authors.forename: Paul M
authors.initials: PM
authors.lastname: Grossman
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012737:Sex Factors; D014481:United States / Q000453:epidemiology