Abstract 6239: The Impact of Hospital Primary Angioplasty Volume in ST-Elevation Myocardial Infarction on Quality and Outcomes: Insights from Get With The Guidelines
Background: Studies have indicated that there is an inverse relationship between hospital volume and adverse outcomes after percutaneous coronary interventions (PCI). We examined the impact of hospital primary angioplasty volume on quality of care and outcomes in patients presenting with STEMI.
Methods: Using data from Get With The Guidelines, 166 PCI capable hospitals were divided into tertiles based on their annual primary angioplasty volume as 0–35 (low), 36–70 (medium), >70 (high). Generalized estimating equation models were used to determine the relationship between primary PCI volume and door-to-balloon times, use of evidence-based guidelines, in-hospital mortality, and length of stay.
Results: A total of 29,513 patients were included, with an overall in-hospital mortality of 3.2%. There was no difference in mortality between the tertiles of PCI volume (3.6% vs. 3.2% vs. 3.1% for low, medium and high volume centers respectively, p=0.12). Sequential modeling also revealed no relationship between hospital volume and in-hospital mortality. After adjusting for patient and hospital characteristics, the odds ratios (OR) for mortality in low volume and medium volume compared with high volume centers were 1.22 (95% CI 0.84–1.76, p=0.29), and 1.11 (95% CI 0.83–1.49, p=0.48), respectively. Median door-to-balloon times were significantly better in high volume centers (98 vs. 90 vs. 88 minutes respectively, p=0.0004). Length of stay was similar between the three groups (4.6 vs. 4.5 vs. 4.6 days respectively, p=0.3). After adjustment for patient and hospital characteristics, high volume centers were more likely than low volume centers to follow AHA guidelines at discharge, including use of aspirin (p=0.04), beta-blockers (p=0.04), and lipid lowering drugs (p=0.03), and smoking cessation counseling (p=0.005).
Conclusions: Our analysis of a large contemporary national registry indicates that compared with low and medium volume PCI centers, high volume centers demonstrate shorter door-to-balloon times and greater use of evidence-based therapies. There is no difference in the adjusted in-hospital mortality or length of hospital stay in patients with STEMI. Future studies will need to determine the impact of PCI volume on longer term outcomes.
This research has received full or partial funding support from the American Heart Association, AHA National Center.