Abstract 6182: Relationship between Institutional Primary Percutaneous Coronary Intervention Volume and Mortality in Hospitals without On-Site Cardiac Surgery: The C-PORT Experience
In hospitals without on-site cardiac surgery that perform stand-alone primary percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI), the relationship between institutional procedure volume and mortality is poorly documented. This relationship was examined in 31 hospitals participating in the Cardiovascular Patient Outcomes Research Team (C-PORT) primary PCI registry. C-PORT hospitals performed only primary, not elective, PCI; none had on-site cardiac surgery. Since 1999, 5737 primary PCI procedures were performed. The median institutional primary PCI volume was 54 procedures per year and overall in-hospital mortality was 3.2 %. Age, hypercholesterolemia, lytic eligibility, hemodynamic instability, extent of coronary artery disease, diabetes and institutional volume were multivariate predictors of mortality. In the figure⇓ below the relationship between volume and risk-adjusted mortality is shown. Hospitals are grouped in terciles of volume so that each tercile contains approximately 1900 patients. Error bars are 95% confidence intervals, and the dotted line is overall mortality. In C-PORT hospitals that perform stand-alone primary PCI, higher volume (median of 83 primary PCI’s per year) is associated with significantly lower mortality and lower volume (median of 46 primary PCI’s per year) is associated with higher mortality. Regardless of volume, STEMI mortality is low and is lower than that historically associated with thrombolytic therapy (6 to 7 %). Nevertheless, increasing institutional procedure volume may further reduce this already low mortality.