title: Differences in the outcome of patients undergoing percutaneous coronary interventions at teaching versus non-teaching hospitals.
abstract: BACKGROUND
  Teaching hospitals have superior outcomes for major medical conditions including cardiovascular disease compared to non-teaching hospitals. This may not be applicable to invasive cardiac procedures given a potential increase in complications due to trainee participation.
  
  
  METHODS
  We assessed the impact of hospital teaching status on the outcome of 89,048 patients who underwent percutaneous coronary intervention (PCI). Teaching hospitals were defined as trainee involvement in greater than 50% of PCIs conducted at that hospital and corresponded to teaching status granted by national accreditation agencies. Unadjusted and risk adjusted analyses were used to determine differences in process of care, morbidity and mortality.
  
  
  RESULTS
  Of 89,048 patients studied, 30,870 received their PCI at teaching hospitals and 58,178 at non-teaching hospitals. Risk-adjusted analysis showed no significant difference in death, in-hospital myocardial infarction, contrast induced nephropathy or gastrointestinal bleeding between teaching and non-teaching hospitals. PCI at teaching hospitals was associated with a lower rate of emergency coronary artery bypass grafting (OR, 0.63; 95% CI, 0.49-0.83; P = .0009) and an increased rate of vascular complications (OR, 1.33; 95% CI, 1.21-1.46; P < .0001).
  
  
  CONCLUSIONS
  General outcomes of patients undergoing PCI are similar across hospital types. However, PCI at teaching hospitals is associated with increased risk of vascular complications and reduced risk of emergency coronary artery bypass grafting compared to non-teaching hospitals.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI; VA Ann Arbor Healthcare System, MI.
authors.forename: Amneet
authors.initials: A
authors.lastname: Sandhu
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
authors.forename: Simon
authors.initials: S
authors.lastname: Dixon
authors.forename: David H
authors.initials: DH
authors.lastname: Wohns
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.forename: Thomas
authors.initials: T
authors.lastname: LaLonde
authors.forename: Dean
authors.initials: D
authors.lastname: Smith
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome