Is the volume-outcome relation still an issue in the era of PCI with systematic stenting? Results of the greater Paris area PCI registry.
OBJECTIVE
In acute myocardial infarction (AMI), primary percutaneous transluminal angioplasty (PTCA) is the preferred option when it can be performed rapidly. Because of the limited access to high PTCA volume centres in some areas, it has been suggested that PTCA could be performed in low-volume centres on AMI patients. Little data exist on the validity of this strategy in modern era PTCA.


RESULTS
The Greater Paris area comprises 11 million inhabitants and accounts for 18% of the French population. In 2001, the hospital agency of the Greater Paris area set up a registry of all PTCAs performed in this region. Data from 2001 and 2002 was analysed. Hospitals performing <400 PTCAs per year were classified as low-volume. A case-control analysis (propensity score) compared in-hospital mortality in low- and high-volume centres. A total of 37 848 angioplasty procedures were performed in 44 centres during the study period; 24.7% were performed in low-volume centres. A non-statistically significant trend towards reduced in-hospital mortality was noted in high-volume centres as opposed to low-volume centres: 2.01 vs. 2.42%, P = 0.057. In-hospital mortality rates were significantly different in the sub-group of emergency procedures: 6.75% in high- vs. 8.54% in low-volume centres, P = 0.028. No difference was noted between low- and high-volume centres in non-emergency procedures (0.62 vs. 0.62%, P = 0.99).


CONCLUSIONS
In the era of modern stenting, a clear inverse relationship exists between hospital PTCA volume and in-hospital mortality after emergency procedures. Tolerance of low-volume thresholds for angioplasty centres with the purpose of providing primary PTCA in AMI should not be recommended, even in underserved areas.
Cardiology Department, Cochin Hospital, Rene Descartes University, Paris, France. christian.spaulding@cch.ap-hop-paris.fr
Christian
C
Spaulding
Marie-Claude
MC
Morice
Bernard
B
Lancelin
Simon
S
El Haddad
Eric
E
Lepage
Sophie
S
Bataille
Jean-Pierre
JP
Tresca
Xavier
X
Mouranche
Sandrine
S
Fosse
Mehran
M
Monchi
Nikita
N
de Vernejoul
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D023921:Coronary Stenosis / Q000150:complications / Q000401:mortality; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010297:Paris / Q000453:epidemiology; D012042:Registries; D012044:Regression Analysis; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D015607:Stents