title: Sirolimus-eluting stent treatment at high-volume centers confers lower mortality at 6-month follow-up: results from the prospective multicenter German Cypher Registry.
abstract: BACKGROUND
  Studies continue to identify percutaneous coronary intervention procedural volume both at the institutional level and at the operator level as being strongly correlated with outcome. High-volume centers have been defined as those that perform >400 percutaneous coronary intervention procedures per year. The relationship between drug-eluting stent procedural volume and outcome is unknown. We investigated this relationship in the German Cypher Registry.
  
  
  RESULTS
  The present analysis included 8201 patients treated with sirolimus-eluting stents between April 2002 and September 2005 in 51 centers. Centers that recruited >400 sirolimus-eluting stent patients in this time period were considered high-volume centers; those with 150 to 400 patients were considered intermediate-volume centers; and those with <150 patients were designated as low-volume centers. The primary end point was all death, myocardial infarction, and target-vessel revascularization at 6 months. This end point occurred in 11.3%, 12.1%, and 9.0% of patients in the low-, intermediate-, and high-volume center groups, respectively (P=0.0001). There was no difference between groups in the rate of target-vessel revascularization (P=0.2) or cerebrovascular accidents (P=0.5). The difference in death/myocardial infarction remained significant after adjustment for baseline factors (odds ratio 1.85, 95% confidence interval 1.31 to 2.59, P<0.001 for low-volume centers; odds ratio 1.69, 95% confidence interval 1.29 to 2.21, P<0.001 for intermediate-volume centers). Patient and lesion selection, procedural features, and postprocedural medications differed significantly between groups.
  
  
  CONCLUSIONS
  The volume of sirolimus-eluting stent procedures performed on an institutional level was inversely related to death and myocardial infarction but not to target-vessel revascularization at 6-month follow-up. Safety issues are better considered in high-volume centers. These findings have important public health policy implications.
authors: Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany. ahmed.khattab@insel.ch
authors: Ahmed A
authors: AA
authors: Khattab
authors: Christian W
authors: CW
authors: Hamm
authors: Jochen
authors: J
authors: Senges
authors: Ralph
authors: R
authors: Toelg
authors: Volker
authors: V
authors: Geist
authors: Tassilo
authors: T
authors: Bonzel
authors: Malte
authors: M
authors: Kelm
authors: Benny
authors: B
authors: Levenson
authors: Christoph A
authors: CA
authors: Nienaber
authors: Thomas
authors: T
authors: Pfannebecker
authors: Georg
authors: G
authors: Sabin
authors: Steffen
authors: S
authors: Schneider
authors: Ulrich
authors: U
authors: Tebbe
authors: Franz-Josef
authors: FJ
authors: Neumann
authors: Gert
authors: G
authors: Richardt
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012042:Registries; D012307:Risk Factors; D020123:Sirolimus; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus