This Article Full Text Full Text (PDF) All Versions of this Article: 112/8/1171    most recent CIRCULATIONAHA.104.528455v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hannan, E. L. Articles by Jones, R. H. Search for Related Content PubMed PubMed Citation Articles by Hannan, E. L. Articles by Jones, R. H. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Coronary Artery Disease Related Collections Catheter-based coronary and valvular interventions: other Catheter-based coronary interventions: stents Related Articles

(Circulation. 2005;112:1171-1179.)
© 2005 American Heart Association, Inc.

Interventional Cardiology

Volume-Outcome Relationships for Percutaneous Coronary Interventions in the Stent Era

Edward L. Hannan, PhD; Chuntao Wu, MD, PhD; Gary Walford, MD; Spencer B. King, III, MD; David R. Holmes, Jr, MD; John A. Ambrose, MD; Samin Sharma, MD; Stanley Katz, MD; Luther T. Clark, MD; Robert H. Jones, MD

From the University at Albany, State University of New York, Albany (E.L.H., C.W.); St Joseph’s Hospital, Syracuse, NY (G.W.); Fuqua Heart Center/Piedmont Hospital, Atlanta, Ga (S.B.K.); Mayo Clinic, Rochester, Minn (D.R.H.); St Vincent’s Hospital and Medical Center, New York, NY (J.A.A.); Mt Sinai Medical Center, New York, NY (S.S.); North Shore-LIJ Health System, Manhasset, NY (S.K.); University Hospital of Brooklyn, Brooklyn, NY (L.T.C.); and Duke University Medical Center, Durham, NC (R.H.J.).

Correspondence to Edward L. Hannan, PhD, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, NY, 12144-3456. E-mail elh03{at}health.state.ny.us

Received December 8, 2004; revision received May 2, 2005; accepted May 3, 2005.

Background— Most studies that are the basis of recommended volume thresholds for percutaneous coronary interventions (PCIs) predate the routine use of stent placement.

Methods and Results— Data from New York’s Percutaneous Coronary Interventions Reporting System in 1998 to 2000 (n=107 713) were used to examine the impact of annual hospital volume and annual operator volume on in-hospital mortality, same-day coronary artery bypass graft (CABG) surgery, and same-stay CABG surgery after adjustment for differences in patients’ severity of illness. For a hospital-volume threshold of 400, the odds ratios for low-volume hospitals versus high-volume hospitals were 1.98 (95% CI, 1.17, 3.35) for in-hospital mortality, 2.07 (95% CI, 1.36, 3.15) for same-day CABG surgery, and 1.51 (95% CI, 1.03, 2.21) for same-stay CABG surgery. For an operator-volume threshold of 75, the odds ratios for low-volume versus high-volume operators were 1.65 (95% CI, 1.05, 2.60) for same-day CABG surgery and 1.55 (95% CI, 1.10, 2.18) for same-stay CABG surgery. Operator volume was not significantly associated with mortality. Also, for hospital volumes below 400 and operator volumes below 75, the respective odds of mortality, same-day CABG surgery, and same-stay CABG surgery were 5.92, 4.02, and 3.92 times the odds for hospital volumes of 400 or higher and operator volumes of 75 or higher.

Conclusions— Higher-volume operators and hospitals continue to experience lower risk-adjusted PCI outcome rates.

Key Words: angioplasty • coronary disease • mortality • revascularization • stents

Related Articles:

Issue Highlights
Circulation 2005 112: 1081. [Extract] [Full Text]

Measuring Percutaneous Coronary Intervention Quality by Simple Case Volume

Richard E. Kuntz and Sharon-Lise T. Normand
Circulation 2005 112: 1088-1091. [Extract] [Full Text]

This article has been cited by other articles:

				M. Singh, B. J. Gersh, R. J. Lennon, H. H. Ting, D. R. Holmes Jr, B. J. Doyle, and C. S. Rihal Outcomes of a System-Wide Protocol for Elective and Nonelective Coronary Angioplasty at Sites Without On-site Surgery: The Mayo Clinic Experience Mayo Clin. Proc., June 1, 2009; 84(6): 501 - 508. [Abstract] [Full Text] [PDF]

				T. J. Iwashyna, J. D. Christie, J. M. Kahn, and D. A. Asch Uncharted Paths: Hospital Networks in Critical Care Chest, March 1, 2009; 135(3): 827 - 833. [Abstract] [Full Text] [PDF]

				V.S. Srinivas, S. M. Hailpern, E. Koss, E. S. Monrad, and M. H. Alderman Effect of physician volume on the relationship between hospital volume and mortality during primary angioplasty. J. Am. Coll. Cardiol., February 17, 2009; 53(7): 574 - 579. [Abstract] [Full Text] [PDF]

				J. G. Jollis The new york state primary angioplasty registry and procedural volume. J. Am. Coll. Cardiol., February 17, 2009; 53(7): 580 - 581. [Full Text] [PDF]

				M. H. Al-Shaer, E. S. Suleiman, W. P. Jerome, E. S. Chu, R. K. Albert, M. Wei, D. van Amerongen, P. K. Lindenauer, M. B. Rothberg, and A. D. Auerbach Outcomes of Care by Hospitalists N. Engl. J. Med., April 17, 2008; 358(16): 1755 - 1758. [Full Text] [PDF]

				S. B. King III, T. Aversano, W. L. Ballard, R. H. Beekman III, M. J. Cowley, S. G. Ellis, D. P. Faxon, E. L. Hannan, J. W. Hirshfeld Jr, A. K. Jacobs, et al. ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures) J. Am. Coll. Cardiol., July 3, 2007; 50(1): 82 - 108. [Full Text] [PDF]

				H. M. Krumholz and F. A. Masoudi The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895. [Full Text] [PDF]

				D. J. Kereiakes and E. M. Antman Clinical Guidelines and Practice: In Search of the Truth J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1129 - 1135. [Abstract] [Full Text] [PDF]

				M. J. Radford Percutaneous Coronary Intervention "Dominates" Coronary Artery Bypass Graft Surgery for High-Risk Patients: Good News for Patients, a Challenge for Healthcare Planners Circulation, September 19, 2006; 114(12): 1229 - 1231. [Full Text] [PDF]

				E. L. Hannan Evaluating and improving the quality of care for acute myocardial infarction: can regionalization help? JAMA, May 10, 2006; 295(18): 2177 - 2179. [Full Text] [PDF]

				H. H. Ting, G. Raveendran, R. J. Lennon, K. H. Long, M. Singh, D. L. Wood, B. J. Gersh, C. S. Rihal, and D. R. Holmes Jr A Total of 1,007 Percutaneous Coronary Interventions Without Onsite Cardiac Surgery: Acute and Long-Term Outcomes J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1713 - 1721. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1689 - 1706. [Full Text] [PDF]

				R. E. Kuntz and S.-L. T. Normand Measuring Percutaneous Coronary Intervention Quality by Simple Case Volume Circulation, August 23, 2005; 112(8): 1088 - 1091. [Full Text] [PDF]