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(Circulation. 2003;108:951.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Edmond W. Chen, MD; John G. Canto, MD; Lori S. Parsons, BS; Eric D. Peterson, MD; Katherine A. Littrell, PhD, RN; Nathan R. Every, MD; C. Michael Gibson, MS, MD; Judith S. Hochman, MD; E. Magnus Ohman, MD; Morris Cheeks, MD; Hal V. Barron, MD, for the Investigators in the National Registry of Myocardial Infarction (NRMI) 2

From the Division of Cardiology (E.W.C.), Kaiser Permanente Medical Group, Inc, Richmond, Calif; Division of Cardiology (E.W.C., H.V.B.), University of California, San Francisco, Calif; Division of Cardiovascular Diseases (J.G.C.), Chest Pain Center and Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, Ala; Ovation Research Group (L.S.P.), Seattle, Wash; Department of Medicine (E.D.P.), Duke University Medical Center, Durham, NC; Department of Medical Affairs (K.A.L., M.C., H.V.B.), Genentech, Inc, South San Francisco, Calif; Northwest HSR&D Field Program (N.R.E., C.M.G.), VA Puget Sound Healthcare System and the University of Washington, Seattle, Wash; Division of Cardiology (J.S.H.), New York University School of Medicine, New York, NY; and Department of Medicine (E.M.O.), Division of Cardiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC.

Correspondence to Edmond W. Chen, MD, Division of Cardiology, Department of Medicine, The Permanente Medical Group, Inc, 901 Nevin Ave, Richmond, CA 94801-3195.

Received July 15, 2002; de novo received February 7, 2003; revision received May 16, 2003; accepted May 21, 2003.

Background— Increasing evidence suggests an inverse relationship between outcome and the total number of invasive cardiac procedures performed at a given hospital. The purpose of the present study was to determine if a similar relationship exists between the number of intra-aortic balloon counterpulsation (IABP) procedures performed at a given hospital per year and the in-hospital mortality rate of patients with acute myocardial infarction complicated by cardiogenic shock.

Methods and Results— We analyzed data of 12 730 patients at 750 hospitals enrolled in the National Registry of Myocardial Infarction 2 from 1994 to 1998. The hospitals were divided into tertiles (low–, intermediate–, and high–IABP volume hospitals) according to the number of IABPs performed at the given hospital per year. The median number of IABPs performed per hospital per year was 3.4, 12.7, and 37.4 IABPs at low-, intermediate-, and high-volume hospitals, respectively. Of those patients who underwent IABP, there were only minor differences in baseline patient characteristics between the 3 groups. Crude mortality rate decreased with increasing IABP volume: 65.4%, lowest volume tertile; 54.1%, intermediate volume tertile; and 50.6%, highest volume tertile (P for trend <0.001). This mortality difference represented 150 fewer deaths per 1000 patients treated at the high IABP hospitals. In the multivariate analysis, high hospital IABP volume for patients with acute myocardial infarction was associated with lower mortality (OR=0.71, 95% CI=0.56 to 0.90), independent of baseline patient characteristics, hospital factors, treatment, and procedures such as PTCA.

Conclusions— Among the myocardial infarction patients with cardiogenic shock who underwent IABP placement, mortality rate was significantly lower at high–IABP volume hospitals compared with low–IABP volume hospitals.

Key Words: mortality • balloon • myocardial infarction • shock • epidemiology

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