Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

Alexander C. Fanaroff, Pearl Zakroysky, David Dai, Daniel Wojdyla, Matthew W. Sherwood, Matthew T. Roe, Tracy Y. Wang, Eric D. Peterson, Hitinder S. Gurm, Mauricio G Cohen, John C. Messenger, Sunil V. Rao

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. Objectives The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. Methods Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. Results The median annual number of procedures performed per operator was 59; 44% of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. Conclusions Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. 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.

Original languageEnglish (US)
Pages (from-to)2913-2924
Number of pages12
JournalJournal of the American College of Cardiology
Volume69
Issue number24
DOIs
StatePublished - Jun 20 2017

Fingerprint

Percutaneous Coronary Intervention
Hospital Mortality
Odds Ratio
Diagnosis-Related Groups
Registries
Dialysis
Emergencies
Guidelines
Hemorrhage

Keywords

  • bleeding
  • mortality
  • myocardial infarction
  • volume-outcome relationship

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fanaroff, A. C., Zakroysky, P., Dai, D., Wojdyla, D., Sherwood, M. W., Roe, M. T., ... Rao, S. V. (2017). Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States. Journal of the American College of Cardiology, 69(24), 2913-2924. https://doi.org/10.1016/j.jacc.2017.04.032

Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States. / Fanaroff, Alexander C.; Zakroysky, Pearl; Dai, David; Wojdyla, Daniel; Sherwood, Matthew W.; Roe, Matthew T.; Wang, Tracy Y.; Peterson, Eric D.; Gurm, Hitinder S.; Cohen, Mauricio G; Messenger, John C.; Rao, Sunil V.

In: Journal of the American College of Cardiology, Vol. 69, No. 24, 20.06.2017, p. 2913-2924.

Research output: Contribution to journalArticle

Fanaroff, AC, Zakroysky, P, Dai, D, Wojdyla, D, Sherwood, MW, Roe, MT, Wang, TY, Peterson, ED, Gurm, HS, Cohen, MG, Messenger, JC & Rao, SV 2017, 'Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States', Journal of the American College of Cardiology, vol. 69, no. 24, pp. 2913-2924. https://doi.org/10.1016/j.jacc.2017.04.032
Fanaroff, Alexander C. ; Zakroysky, Pearl ; Dai, David ; Wojdyla, Daniel ; Sherwood, Matthew W. ; Roe, Matthew T. ; Wang, Tracy Y. ; Peterson, Eric D. ; Gurm, Hitinder S. ; Cohen, Mauricio G ; Messenger, John C. ; Rao, Sunil V. / Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States. In: Journal of the American College of Cardiology. 2017 ; Vol. 69, No. 24. pp. 2913-2924.
@article{9b5a54dfbb9f4c49b81c231ee998dffd,
title = "Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States",
abstract = "Background Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. Objectives The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. Methods Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. Results The median annual number of procedures performed per operator was 59; 44{\%} of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86{\%} for low-volume operators, 1.73{\%} for intermediate-volume operators, and 1.48{\%} for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. Conclusions Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. 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.",
keywords = "bleeding, mortality, myocardial infarction, volume-outcome relationship",
author = "Fanaroff, {Alexander C.} and Pearl Zakroysky and David Dai and Daniel Wojdyla and Sherwood, {Matthew W.} and Roe, {Matthew T.} and Wang, {Tracy Y.} and Peterson, {Eric D.} and Gurm, {Hitinder S.} and Cohen, {Mauricio G} and Messenger, {John C.} and Rao, {Sunil V.}",
year = "2017",
month = "6",
day = "20",
doi = "10.1016/j.jacc.2017.04.032",
language = "English (US)",
volume = "69",
pages = "2913--2924",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "24",

}

TY - JOUR

T1 - Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States

AU - Fanaroff, Alexander C.

AU - Zakroysky, Pearl

AU - Dai, David

AU - Wojdyla, Daniel

AU - Sherwood, Matthew W.

AU - Roe, Matthew T.

AU - Wang, Tracy Y.

AU - Peterson, Eric D.

AU - Gurm, Hitinder S.

AU - Cohen, Mauricio G

AU - Messenger, John C.

AU - Rao, Sunil V.

PY - 2017/6/20

Y1 - 2017/6/20

N2 - Background Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. Objectives The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. Methods Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. Results The median annual number of procedures performed per operator was 59; 44% of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. Conclusions Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. 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.

AB - Background Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. Objectives The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. Methods Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (<50 PCIs per year), intermediate- (50 to 100 PCIs per year), and high- (>100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. Results The median annual number of procedures performed per operator was 59; 44% of operators performed <50 PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. Conclusions Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. 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.

KW - bleeding

KW - mortality

KW - myocardial infarction

KW - volume-outcome relationship

UR - http://www.scopus.com/inward/record.url?scp=85020673555&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020673555&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2017.04.032

DO - 10.1016/j.jacc.2017.04.032

M3 - Article

C2 - 28619191

AN - SCOPUS:85020673555

VL - 69

SP - 2913

EP - 2924

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 24

ER -