title: Optimal catchment area and primary PCI centre volume revisited: a single-centre experience in transition from high-volume centre to "mega centre" for patients with ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres, creating one mega centre serving 2.5 million inhabitants, and performing ~1,000 procedures/year.
  
  
  RESULTS
  In this descriptive cohort study, we linked individual-level data from the national Central Population Register holding survival status with our in-hospital dedicated PCI database of baseline, organisational and procedural characteristics. Quality measures were treatment delays and 30-day all-cause mortality. In the three-year study period, 2,066 consecutive pPCIs were performed. After the fusion of the two centres, pPCI procedures increased by 102%, while door-to-balloon remained stable at 32 minutes. Up to 75.1% of patients were directly transferred by pre-hospital triage, of whom 82.7% had ECG-to-balloon <120 min, 92.6% had door-to-balloon <60 min. Thirty-day all-cause mortality remained low at 6.3%.
  
  
  CONCLUSIONS
  This study challenges the stated maximal pPCI centre volume. The quality of a centre reflects governance, training, resources and pre-hospital triage, rather than catchment population and STEMI incidence, as long as a minimum volume is guaranteed. Resources can be utilised better by merging neighbouring centres, without negative effects on quality of care.
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mikkel Malby
authors.initials: MM
authors.lastname: Schoos
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.forename: Lene
authors.initials: L
authors.lastname: Holmvang
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamaki
authors.forename: Steffen
authors.initials: S
authors.lastname: Helqvist
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
mesh_terms: D000368:Aged; D002391:Catchment Area, Health; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage