title: Clinical outcomes in a community-based single operator coronary interventional program.
abstract: BACKGROUND
  Physicians who perform fewer than 75 coronary interventional procedures annually and centers where fewer that 200 procedures are performed annually are considered to be low-volume and likely to have higher procedural risk and suboptimal outcomes.
  
  
  METHODS
  This was assessed in a retrospective analysis of clinical outcomes in 559 patients who underwent multi-device coronary interventions from 1994 through 2002 (prior to and during the bare metal stent era) performed by a single operator in a community hospital setting with on-site cardiac surgical services.
  
  
  RESULTS
  ST- and non-ST-elevation myocardial infarction was present in 36.5% and 10.2% of the population, respectively, with 12.3% of ST-elevation myocardial infarction patients presenting with acute cardiogenic shock. Mortality in all patient subsets was less than 1% when patients with ST-elevation myocardial infarction and cardiogenic shock were excluded. The 6-month target lesion revascularization rate for all devices and in all patient subsets during the study period was 9.1%, and for those treated with coronary stents, the rate was 7.8%. From 1999 through 2002, the rates were 2.1% and 1.9%, respectively.
  
  
  CONCLUSIONS
  A low-volume coronary interventional program can achieve angiographic percutaneous coronary interventional success rates and major adverse cardiac events and the need for target lesion revascularization comparable to those in high-volume major cardiac referral centers. These results were obtained even when high-risk patients with ST-elevation myocardial infarction were not excluded from the analysis.
authors.affiliation: Mercy Heart and Vascular Center, 1000 Mineral Point Ave, Janesville, WI 53548, USA. cposner@mhsjvl.org
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Posner
authors.forename: Carol L
authors.initials: CL
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D017225:Atherectomy, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy; D016896:Treatment Outcome