Abstract 16550: Physician Annual Volume and In-Hospital Mortality Following Percutaneous Coronary Intervention
Introduction: Although ACC/AHA/ESC guidelines recommend that physicians perform a total volume of >=75 PCI annually, there is conflicting data supporting this recommendation. We assessed the 75 PCI/year threshold using data from the NCDR CathPCI Registry.
Methods: We identified physicians who performed at least 10 PCI at 543 CathPCI hospitals over 4 consecutive quarters ending July 2009. PCI volume was calculated using physician UPIN to account for physicians who performed PCI at >1 hospital (n=867, 22.7%). We compared characteristics, cardiac status, and in-hospital mortality of patients treated by physicians who performed <75 cases with those who performed >=75 PCI/year, and further stratified by indication (STEMI/Shock and no STEMI/no Shock). To account for variation in case mix and clustering by physician, we estimated hierarchical logistic regression models adjusting for patient demographics, comorbidities, cardiac status, and hospital volume.
Results: The study population included 3649 physicians who performed 345,526 PCI. The median physician PCI volume was 75 PCI (IQR 38-127). Crude in-hospital mortality was 1.31% (n=4541), and varied by physician volume (<75:1.55%, >=75: 1.25%, P <0.001). The adjusted odds of in-hospital mortality was statistically significantly higher among physicians performing <75 PCIs (Table). The strength of the volume-outcome relationship was more pronounced among no STEMI/no Shock patients than STEMI/Shock patients.
Conclusions: We observed a higher risk of in-hospital mortality among cases performed by physicians who performed <75 PCI compared with physicians who performed >=75 PCI. However, the absolute differences in mortality were small. These results are consistent with current guidelines, but further investigation is necessary to fully characterize the volume-outcome relationship.
- © 2011 by American Heart Association, Inc.