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The ACCF/AHA/SCAI 2013 update on percutaneous coronary intervention (PCI) clinical competency reduced the minimal physician requirements from 75 annual PCI's to 50 per year (averaged over two years). This reduction has occurred while the complexity of PCI has increased. Multiple studies have demonstrated an association between increased operator volume and a reduction in mortality. This is the first study to assess if there is further benefit in reducing mortality at the extremes of operator volume.
Data from New York's Percutaneous Coronary Interventions Reporting System in 2011 to 2013 (n=145,247) were used to examine the impact of operator volume on in-hospital mortality or after discharge but within 30 days. Cases were analyzed, based on operator's volume during the reporting period.
The statewide average observed mortality rate (OMR) during the period reviewed was 1.04. Mortality rates by operator volume are presented in Table 1. Increased operator volume was significantly associated with decreased mortality. For operator volumes below 2,000, the odds of mortality, were 2.6 times the odds for operator volumes of 2,000 or higher (95% CI, 1.89, 3.61; p<0.0001).
Despite a decreased focus in the guidelines on higher volume, we have confirmed an association with decreasing mortality and increased operator volume. Notably, within the highest volume bracket, mortality rates are further reduced in half. With the specialization of innovative devices and increasing complexity of PCI, there may be an increased importance of high annual volume.
CORONARY: PCI Outcomes