Does PCI Volume Affect Patient Mortality?

In-hospital patient mortality has risen while the volume of percutaneous coronary intervention (PCI) procedures performed by operators has dropped, according to a recent study.

The recommended minimum annually performed PCIs was lowered to an average of 50 per operator. However, since the change, operator volume and the outcomes associated with the change are unknown.
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To investigate this gap, the researchers evaluated operator annual PCI volume from July 1, 2009, until March 31, 2015, using data from the National Cardiovascular Data Registry. Operators were divided into groups of low-volume (less than 50 PCIs per year), intermediate-volume (50 to 100 PCIs per year), and high-volume (more than 100 PCIs per year).

Using this information, the researchers calculated the adjusted association between annual PCI volume and in-hospital outcomes, including mortality.

Results showed that operators performed an average of 59 PCI procedures per year. About 44% of operators included in the study were classified as low-volume operators and more frequently performed emergency and primary PCI procedures in hospitals with lower annual PCI volumes.

The researchers calculated unadjusted in-hospital mortality to be 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators.

Low- and intermediate-volume operators demonstrated a higher adjusted risk of in-hospital mortality compared with high-volume operators. The same result was observed with the risk for new dialysis post-PCI. However, the researchers did not observe any volume relationship for post-PCI bleeding.

“Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually,” the researchers concluded. “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.”

—Christina Vogt

Reference:

Fanaroff AC, Zakroysky P, Dai D, et al. Outcomes of PCI in relation to procedural characteristics and operator volumes in the United States. J Am Coll Cardiol. 2017;69(24). doi:10.1016/j.jacc.2017.04.032.