Author + information
- William Hulme1,
- Matthew Sperrin2,
- Nick Curzen3,
- Tim Kinnaird4,
- Mark de Belder5,
- Peter Ludman6,
- Chun Shing Kwok7,
- Christopher Gale8,
- Evan Kontopantelis9 and
- Mamas Mamas7
- 1University manchester, manchester, United Kingdom
- 2University of manchester, manchester, United Kingdom
- 3University Hospital Southampton, Southampton, United Kingdom
- 4UHW, penarth, United Kingdom
- 5The James Cook University Hospital, Middlesbrough, United Kingdom
- 6Queen Elizabeth Hospital, Birmingham, United Kingdom
- 7Keele University, Stoke-on-Trent, United Kingdom
- 8Leeds University, Leeds, United Kingdom
- 9Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Germany
The relationship between operator volume and outcomes for percutaneous coronary intervention has been studied in the past, but recent analyses of national data covering the modern radial, ACS-dominant era are limited. Changing in case-mix, practice and service provision mean that previously described volume-outcome relationships may no longer be relevant, and a reassessment in contemporary practice is needed. We aim to assess whether operator volume is associated with independently reported 30-day mortality in a contemporary PCI cohort.
This observational cohort study analysed procedures recorded in the British Cardiovascular Intervention Society PCI database from 2013 to 2014 in England and Wales. Mixed effects multiple logistic regression modelling was used to account for operator and centre level effects and to adjust for potential confounders. Volume is defined as the total number of PCI procedures the operator was responsible for in the previous 12 months.
133,970 procedures were analysed. Median volume across all procedures was 178 per year (IQR 128-239). The 30-day mortality rate was 2.6%. After adjustment for case-mix, the association between volume and mortality was negligible (Odds-ratio per 100 procedures = 0.99, 95% CI = 0.93 to 1.05, p=0.725).
There is no evidence that mortality differs by operator volume in the United Kingdom. Volume-outcome relationships in PCI should be carefully monitored in response to future changes in practice.
OTHER: Quality, Guidelines and Appropriateness Criteria