The relationship between operator volume and outcomes after percutaneous coronary interventions in high volume hospitals in 1994-1996 - The northern New England experience

OBJECTIVES The purpose of this study was to examine the relationship between annual operator volume and outcomes of percutaneous coronary interventions (PCIs) using contemporaneous data. BACKGROUND The 1997 American College of Cardiology (ACC)/American Heart Association task force based their recommendation that interventionists perform greater than or equal to 75 procedures per year to maintain competency in PCI on data collected largely in the early 1990s. The practice of interventional cardiology has since changed with the availability of new devices and drugs. METHODS Data were collected from 1994 through 1996 on 15,080 PCIs performed during 14,498 hospitalizations by 47 interventional cardiologists practicing at the five high volume (>600 procedures per hospital per year) hospitals in northern New England and one Massachusetts-based institution that support these procedures. Operators were categorized into terciles based on their annualized volume of procedures. Multivariate regression analysis was used to control for case-mix. In-hospital outcomes included death, emergency coronary artery bypass graft surgery (eCABG), non-emergency CABG (non-eCABG), myocardial infarction (MI), death and clinical success (greater than or equal to 1 attempted lesion dilated to <50% residual stenosis and no death, CABG or MI). RESULTS Average annual procedure rates varied across terciles from low = 68, middle = 115 and high = 209. After adjusting for case-mix, clinical success rates were comparable across terciles (low, middle and high terciles: 90.9%, 88.8% and 90.7%, p(trend) = 0.237), as were all the adverse outcomes including death (low-risk patients = 0.45%, 0.41%, 0.71%, p(trend) = 0.086; high-risk patients = 5.68%, 5.99%, 7.23%, p(trend) = 0.324), eCABG (1.74%, 2.05%, 1.75%, p(trend) = 0.733) and MI (2.57%, 1.90%, 1.86%, p(trend) = 0.065). CONCLUSIONS Using current data, there is no significant relationship between operator Volumes averaging greater than or equal to 68 per year and outcomes at high Volume hospitals. Future efforts should be directed at determining the generalizability of these results. (C) 1999 by the American College of Cardiology.