title: Association of Physician Certification in Interventional Cardiology With In-Hospital Outcomes of Percutaneous Coronary Intervention.
abstract: BACKGROUND
  The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010.
  
  
  RESULTS
  We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups.
  
  
  CONCLUSIONS
  We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Paul N
authors.initials: PN
authors.lastname: Fiorilli
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Karl E
authors.initials: KE
authors.lastname: Minges
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lipner
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hess
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Brennan
authors.affiliation: From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.). jeptha.curtis@yale.edu.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
mesh_terms: D000368:Aged; D016507:Cardiology Service, Hospital / Q000592:standards*; D002568:Certification / Q000592:standards*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000592:standards*; D010820:Physicians / Q000592:standards*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: acute coronary syndromes; acute myocardial infarction; angioplasty; catheter-based coronary interventions, stents; chronic ischemic heart disease; coronary revascularization; health policy and outcome research; registries