Author + information
- Received March 8, 2017
- Revision received April 6, 2017
- Accepted April 7, 2017
- Published online June 12, 2017.
- Alexander C. Fanaroff, MDa,b,∗ (, )
- Pearl Zakroysky, MSb,
- David Dai, MSb,
- Daniel Wojdyla, PhDb,
- Matthew W. Sherwood, MD, MHSb,d,
- Matthew T. Roe, MD, MHSa,b,
- Tracy Y. Wang, MD, MHS, MSca,b,
- Eric D. Peterson, MD, MPHa,b,
- Hitinder S. Gurm, MDe,
- Mauricio G. Cohen, MDf,
- John C. Messenger, MDg and
- Sunil V. Rao, MDa,b,c
- aDivision of Cardiology, Duke University, Durham, North Carolina
- bDuke Clinical Research Institute, Duke University, Durham, North Carolina
- cDurham Veterans Affairs Medical Center, Durham, North Carolina
- dDivision of Cardiology, Inova Heart and Vascular Institute, Falls Church, Virginia
- eDivision of Cardiology, University of Michigan, Ann Arbor, Michigan
- fCardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
- gDivision of Cardiology, University of Colorado, Aurora, Colorado
- ↵∗Address for correspondence:
Dr. Alexander C. Fanaroff, Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, North Carolina 27705.
Background Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown.
Objectives The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample.
Methods Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality.
Results The median annual number of procedures performed per operator was 59; 44% of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding.
Conclusions Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. Although absolute risk differences are small and may be partially explained by unmeasured differences in case mix between operators, there remains an inverse relationship between PCI operator volume and in-hospital mortality that persisted in risk-adjusted analyses.
Dr. Fanaroff has received funding from Gilead Science. Dr. Roe has received research funds from Eli Lilly, Sanofi, Daiichi-Sankyo, Janssen Pharmaceuticals, Ferring Pharmaceuticals, Myokardia, and AstraZeneca; and has received consulting fees from PriMed, AstraZeneca, Boehringer Ingelheim, Merck, Actelion, Amgen, Myokardia, Eli Lilly, Novartis, Daiichi-Sankyo, Quest Diagnostics, and Elsevier Publishers. Dr. Wang has received funding from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, Daiichi-Sankyo, Lily USA, Pfizer, Regeneron, and Gilead. Dr. Rao has received consultant fees from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 8, 2017.
- Revision received April 6, 2017.
- Accepted April 7, 2017.
- 2017 American College of Cardiology Foundation