title: Volume-outcomes relationship in the era of modern coronary intervention-results from the prospective multicenter German DES.DE Registry.
abstract: OBJECTIVE
  We compare clinical outcomes among unselected patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) stratified in categories of treating hospital PCI volume.
  
  
  BACKGROUND
  Previous observational evidence suggests an inverse relation between hospital volume and patients' outcomes. However, there are no mid-term outcomes data with the use of DES.
  
  
  METHODS
  We used data from DES.DE (German Drug-Eluting Stent) registry to compare in-hospital and 1-year outcomes among unselected patients. Primary endpoints at one year follow-up were the rate of major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR).
  
  
  RESULTS
  Between 2005 and 2006, 2,075 patients were treated in group I hospitals (<1,000 PCIs/year), 1,624 in group II hospitals (1,000-1,500 PCIs/year), and 1,790 in group III hospitals (>1,500 PCIs/year). Compared with group II and group III, group I allocation was associated with higher rates of overall hospital mortality (1.1% versus 0.2% versus 0.2%; P < 0.0001) and severe bleeding (1.0% versus 0.4% versus 0.5%; P < 0.05); similarly, poorer outcomes with respect to MACCE (7.2% versus 6.5% versus 4.7%; P < 0.01), stent thrombosis (5.2% versus 5.0% versus 3.0%; P < 0.01), and non-fatal stroke (1.5% versus 0.9% versus 0.7%; P < 0.05) were documented in group I. Conversely, TVR rates were highest in group II (10.2% versus 14.2% versus 11.7%; P < 0.01); these differences persisted after risk adjustment for heterogeneous baseline characteristics.
  
  
  CONCLUSIONS
  In the era of modern coronary intervention technological advances such as DES have not offset the inverse relation between procedural volume and both in-hospital and 1-year outcomes after PCI.
authors.affiliation: Heart Center Rostock, Divisions of Cardiology, Pulmology and Intensive Care Unit, Department of Internal Medicine I, University Hospital Rostock, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Mathias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000209:etiology; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: PCI volume; mortality; restenosis; stents; thrombosis