Relationship between operator volume and adverse outcome in contemporary percutaneous coronary intervention practice: an analysis of a quality-controlled multicenter percutaneous coronary intervention clinical database.
OBJECTIVE
The aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database.


BACKGROUND
Whether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear.


METHODS
Data on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay.


RESULTS
The unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38% and 6.13% vs. 4.15%, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63% increased odds of MACE (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95% CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients.


CONCLUSIONS
Although the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs.
Moscucci
Mauro
M
Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0311, USA. moscucci@med.umich.edu
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David
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Smith
Dean
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O'Donnell
Michael J
MJ
Riba
Arthur
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McNamara
Richard
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Lalonde
Thomas
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Defranco
Anthony C
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Kline Rogers
Eva
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D'Haem
Chris
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Karve
Milind
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Eagle
Kim A
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D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data*; D023921:Coronary Stenosis / Q000628:therapy*; D019992:Databases as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome