Author + information
- Taku Inohara,
- Shun Kohsaka,
- Kyohei Yamaji,
- Tetsuya Amano,
- Kenshi Fujii,
- Hirotaka Oda,
- Shiro Uemura,
- Kazushige Kadota,
- Hiroaki Miyata and
- Masato Nakamura
Background: The effect of site and operator case load for percutaneous coronary intervention (PCI) on outcomes has not been thoroughly investigated in non-Western regions. The aim of this study was to assess the volume-outcome relationship for PCI within the nationwide registration system in Japan.
Methods: In the present study, PCI procedural data recorded in Japanese PCI registry (J-PCI), which is a Japanese nationwide registration system, between January 2014 and December 2015 were analyzed. Institutions and operators were categorized into deciles on the basis of their volumes of PCI per year. Odds ratios for in-hospital mortality and composite endpoint (in-hospital death and peri-procedural complications) were estimated for each decile (with the lowest volume group as a reference group).
Results: A total of 323,278 PCIs (at 625 hospitals [median PCI cases/year: 216, quartiles: 121-332] by 4173 operators [median PCI cases/year: 24, quartiles: 9-47]) were analyzed, of which 2957 (0.9%) and 7204 patients (2.2%) experienced in-hospital mortality and composite endpoint after PCI, respectively. The adjusted risk for in-hospital mortality and composite endpoint were significantly higher in the hospitals included in the lowest decile (<150 PCIs/year); the risk remained consistently low across remainder of the deciles. Spline relationship also demonstrated that the predicted probabilities of in-hospital mortality and composite endpoint dropped with increasing institutional PCI volume and flattened at approximately >100 procedures per year. In the contrast, no significant volume-outcome relationship was observed between the operator volume and outcomes. Similar trend was observed when the analysis was confined to emergent/urgent PCI cases.
Conclusions: In the contemporary Japanese PCI practice, a lower institutional volume was associated with inverse in-hospital outcomes, although the threshold for the minimum requirement for PCIs performed annually could be lower than that of current consensus in Western countries, whereas association of an operator annual PCI volume and outcomes was less apparent.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Complexity and Complications
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1285-170
- 2017 American College of Cardiology Foundation