PCI at Top- and Non-Ranked Hospitals

Study Questions:

What is the appropriate use and outcomes of percutaneous coronary intervention (PCI) between top-ranked and non-ranked hospitals?

Methods:

The investigators classified hospitals in the National Cardiovascular Data Registry CathPCI registry between July 1, 2014 and June 30, 2015 as top-ranked if they were included in the 2015 U.S. News & World Report’s 50 best “Cardiology and Heart Surgery” hospitals. The remaining were classified as non-ranked. They compared in-hospital mortality, post-procedural bleeding, post-procedural acute kidney injury (AKI), and the proportion of appropriate PCI procedures between top-ranked and non-ranked hospitals.

Results:

A total of 509,153 PCIs at 654 hospitals were included, of which 55,550 (10.9%) were performed at 44 top-ranked hospitals. After adjusting for patient case mix, PCIs performed at top-ranked hospitals had similar odds of in-hospital mortality (adjusted odds ratio [aOR], 0.96; 95% confidence interval [CI], 0.83-1.12; p = 0.64), AKI (aOR, 1.10; 95% CI, 0.98-1.22; p = 0.099), and bleeding (aOR, 1.15; 95% CI, 0.999-1.31; p = 0.052). Top-ranked hospitals had a slightly lower proportion of appropriate PCI compared with non-ranked hospitals (89.2% vs. 92.8%; OR, 0.56; 95% CI, 0.45-0.69; p < 0.001).

Conclusions:

The authors concluded that PCI performed at top-ranked hospitals was not associated with superior outcomes compared with PCI at non-ranked hospitals.

Perspective:

This observational study found no evidence to suggest that PCI at non-ranked hospitals resulted in inferior clinical outcomes compared with top-ranked hospitals. This finding was consistent among the subgroup of elective PCIs. Furthermore, when evaluated individually with respect to hospital-level mortality ratios, no top-ranked hospital was found to be a high-performing outlier demonstrating exceptional performance. Future hospital ratings may consider including clinical measures of PCI appropriateness and outcomes for robustness, and it is important for hospitals, registries, and professional organizations to assist in public reporting efforts aimed at improving transparency, accountability, and quality in health care.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Acute Kidney Injury, AHA17, AHA Annual Scientific Sessions, American Heart Association, CathPCI Registry, Diagnosis-Related Groups, Hemorrhage, Hospital Mortality, Outcome Assessment (Health Care), Percutaneous Coronary Intervention, Vascular Diseases


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