The Challenges of Success: Maintaining Access to High Quality PCI in the Face of Declining Procedural Volumes
Over the past several decades, major changes in lifestyle, preventive care, and clinical management have contributed to an impressive reduction in coronary artery disease (CAD) prevalence, incident acute myocardial infarction (AMI), and deaths due to coronary heart disease1-3. As a result, use of cardiovascular services in the United States has decreased dramatically in recent years. For patients with CAD, advances in medical management have allowed more and more patients to avoid elective catheterization procedures, while the results of recent studies (e.g. COURAGE4, FAME5, and SYNTAX6) have led to more judicious use of PCI in patients with chronic CAD. The combined effect of these trends has been a marked reduction in overall PCI volumes7, from a peak of nearly 1 million in the US in 2006 to approximately 600,000 in recent years8. At the same time as overall PCI volumes have been decreasing, the number of PCI centers has been increasing as data have emerged indicating that the absence of on-site cardiac surgery does not adversely impact patient outcomes after either emergent or elective PCI9, 10. Together, declining PCI volumes and the increasing number of PCI centers has led to a decrease in volume of PCI procedures at both the center and operator level11.
- Received September 2, 2014.
- Accepted September 2, 2014.