Relationship between operator volume and adverse outcome in contemporary percutaneous coronary intervention practice

An analysis of a quality-controlled multicenter percutaneous coronary intervention clinical database

Mauro Moscucci, David Share, Dean Smith, Michael J. O'Donnell, Arthur Riba, Richard McNamara, Thomas Lalonde, Anthony C. Defranco, Kirit Patel, Eva Kline Rogers, Chris D'Haem, Milind Karve, Kim A. Eagle

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

OBJECTIVES: The aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database. BACKGROUND: Whether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear. METHODS: Data on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay. RESULTS: The unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38% and 6.13% vs. 4.15%, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63% increased odds of MACE (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95% CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients. CONCLUSIONS: Although the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs.

Original languageEnglish
Pages (from-to)625-632
Number of pages8
JournalJournal of the American College of Cardiology
Volume46
Issue number4
DOIs
StatePublished - Aug 16 2005

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Percutaneous Coronary Intervention
Databases
Odds Ratio
Confidence Intervals
Transient Ischemic Attack
Hospital Mortality
Coronary Artery Bypass
Stents
Comorbidity
Length of Stay
Stroke
Myocardial Infarction
Physicians

ASJC Scopus subject areas

  • Nursing(all)

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Relationship between operator volume and adverse outcome in contemporary percutaneous coronary intervention practice : An analysis of a quality-controlled multicenter percutaneous coronary intervention clinical database. / Moscucci, Mauro; Share, David; Smith, Dean; O'Donnell, Michael J.; Riba, Arthur; McNamara, Richard; Lalonde, Thomas; Defranco, Anthony C.; Patel, Kirit; Kline Rogers, Eva; D'Haem, Chris; Karve, Milind; Eagle, Kim A.

In: Journal of the American College of Cardiology, Vol. 46, No. 4, 16.08.2005, p. 625-632.

Research output: Contribution to journalArticle

Moscucci, Mauro ; Share, David ; Smith, Dean ; O'Donnell, Michael J. ; Riba, Arthur ; McNamara, Richard ; Lalonde, Thomas ; Defranco, Anthony C. ; Patel, Kirit ; Kline Rogers, Eva ; D'Haem, Chris ; Karve, Milind ; Eagle, Kim A. / Relationship between operator volume and adverse outcome in contemporary percutaneous coronary intervention practice : An analysis of a quality-controlled multicenter percutaneous coronary intervention clinical database. In: Journal of the American College of Cardiology. 2005 ; Vol. 46, No. 4. pp. 625-632.
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abstract = "OBJECTIVES: The aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database. BACKGROUND: Whether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear. METHODS: Data on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay. RESULTS: The unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38{\%} and 6.13{\%} vs. 4.15{\%}, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63{\%} increased odds of MACE (adjusted odds ratio [OR] 1.63, 95{\%} confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95{\%} CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients. CONCLUSIONS: Although the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs.",
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T1 - Relationship between operator volume and adverse outcome in contemporary percutaneous coronary intervention practice

T2 - An analysis of a quality-controlled multicenter percutaneous coronary intervention clinical database

AU - Moscucci, Mauro

AU - Share, David

AU - Smith, Dean

AU - O'Donnell, Michael J.

AU - Riba, Arthur

AU - McNamara, Richard

AU - Lalonde, Thomas

AU - Defranco, Anthony C.

AU - Patel, Kirit

AU - Kline Rogers, Eva

AU - D'Haem, Chris

AU - Karve, Milind

AU - Eagle, Kim A.

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N2 - OBJECTIVES: The aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database. BACKGROUND: Whether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear. METHODS: Data on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay. RESULTS: The unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38% and 6.13% vs. 4.15%, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63% increased odds of MACE (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95% CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients. CONCLUSIONS: Although the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs.

AB - OBJECTIVES: The aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database. BACKGROUND: Whether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear. METHODS: Data on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay. RESULTS: The unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38% and 6.13% vs. 4.15%, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63% increased odds of MACE (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95% CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients. CONCLUSIONS: Although the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs.

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