NCDR Study Looks at Use of In-Hospital Risk-Adjusted Mortality to Determine PCI Quality

In-hospital risk-adjusted mortality rates should not be the only metric used to evaluate percutaneous coronary intervention (PCI) quality, according to a study published April 3 in JACC: Cardiovascular Interventions.

The study, by Jacob A. Doll, MD, et al., gathered data from ACC’s CathPCI Registry between Oct. 1, 2009 and Sept. 30, 2014 to calculate the mean risk-standardized mortality rate (RSMR) for PCI operators with an average annual volume of ≥50 cases. Of the 2,352,174 PCIs performed by 3,760 operators, 242 (6.5 percent) were classified as high outliers, while 156 operators (4.1 percent) were classified as low outliers. The non-outlier group included the remaining 3,362 operators.

Results showed a median operator annual volume of 103 PCI procedures with 1.5 percent overall in-hospital mortality. The authors also found significant differences in annual operator RSMR, unexplained by case mix or procedure characteristics. Operator classifications also varied throughout the study, for example, the average non-outlier operator had a high RSMR 0.29 of the five years studied.

PCI mortality rates for individual doctors may be useful for both doctors and hospitals to assess and monitor their care and see where they need improvement, explains Doll. “It could drive hospitals and doctors to further improve the safety of a procedure that’s already low-risk. However, I don’t see this measure as ready for widespread use as a publicly reported measure or to influence payment,” he adds.

In an accompanying editorial comment, Michael McDaniel, MD, FACC, notes that “in-hospital risk adjusted morality is an imprecise and probably inaccurate reflection of the quality of a PCI procedure. Moreover, reporting mortality after PCI can promote risk averse behaviors.” Moving forward, he suggests quality of care for patients with coronary artery disease would be more informed “if risk adjusted mortality were measured based on clinical presentation, included all patients regardless of treatment strategy, and evaluated over longer periods of time rather than in-hospital.”

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease

Keywords: Coronary Artery Disease, Diagnosis-Related Groups, Hospital Mortality, Hospitals, Percutaneous Coronary Intervention, Registries, National Cardiovascular Data Registries, CathPCI Registry

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