Operator Volume and Mortality After PCI

Study Questions:

What is the association of operator volume with independently reported 30-day mortality in a contemporary percutaneous coronary intervention (PCI) cohort?

Methods:

The investigators conducted an observational cohort study and analyzed procedures recorded in the British Cardiovascular Intervention Society PCI database from 2013 to 2014 in England and Wales. Mixed-effects multiple logistic regression modeling was used to account for operator and center-level effects and to adjust for potential confounders. Volume was defined as the total number of procedures the operator was responsible for in the previous 12 months.

Results:

A total of 133,970 procedures were analyzed. Median volume across all procedures was 178 per year (interquartile range, 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% confidence interval, 0.93–1.05; p = 0.725). Sensitivity analyses showed similar results among high-risk PCI subsets and in-hospital outcomes.

Conclusions:

The authors concluded that there is no evidence that mortality differs by operator volume.

Perspective:

This contemporary nationally representative study from the United Kingdom showed no relationship between 30-day mortality following PCI and the number of cases performed by a PCI operator. Furthermore, similar results were obtained in analyses of acute coronary syndrome-only and primary PCI-only procedures, and of center-reported in-hospital mortality and in-hospital major adverse cardiac events. One caveat is that there were only a few truly low-volume operators. These data appear to suggest that increasing PCI volume is not associated with better mortality outcomes in the contemporary era. Volume-related outcome patterns in the PCI setting need re-assessment and have implications for credentialing and recertification requirements.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Acute Coronary Syndrome, Certification, Credentialing, Hospital Mortality, Mortality, Outcome Assessment (Health Care), Percutaneous Coronary Intervention


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