TY - JOUR
T1 - Impact of Institutional and Operator Volume on Short-Term Outcomes of Percutaneous Coronary Intervention
T2 - A Report From the Japanese Nationwide Registry
AU - Inohara, Taku
AU - Kohsaka, Shun
AU - Yamaji, Kyohei
AU - Amano, Tetsuya
AU - Fujii, Kenshi
AU - Oda, Hirotaka
AU - Uemura, Shiro
AU - Kadota, Kazushige
AU - Miyata, Hiroaki
AU - Nakamura, Masato
AU - Inohara, Taku
AU - Kohsaka, Shun
AU - Yamaji, Kyohei
AU - Amano, Tetsuya
AU - Fujii, Kenshi
AU - Oda, Hirotaka
AU - Uemura, Shiro
AU - Kadota, Kazushige
AU - Miyata, Hiroaki
AU - Nakamura, Masato
AU - Kadota, Kazushige
AU - Shiode, Nobuo
AU - Tanaka, Nobuhiro
AU - Amano, Tetsuya
AU - Uemura, Shiro
AU - Akasaka, Takashi
AU - Morino, Yoshihiro
AU - Fujii, Kenshi
AU - Hikichi, Hiroshi
AU - Amano, Tetsuya
AU - Fujii, Kenshi
AU - Kohsaka, Shun
AU - Ishii, Hideki
AU - Tanabe, Kengo
AU - Ozaki, Yukio
AU - Sumitsuji, Satoru
AU - Iida, Osamu
AU - Hara, Hidehiko
AU - Takashima, Hiroaki
AU - Shirai, Shinichi
AU - Nansato, Mamoru
AU - Inohara, Taku
AU - Ueda, Yasunori
AU - Numasawa, Yohei
AU - Noma, Shigetaka
N1 - Publisher Copyright:
© 2017 American College of Cardiology Foundation
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2017/5/8
Y1 - 2017/5/8
N2 - Objectives The aim of this study was to assess the volume–outcome relationship for PCI within the nationwide registration system in Japan. Background The effect of site and operator case load for percutaneous coronary intervention (PCI) on outcomes has not been investigated thoroughly in non-Western regions. Methods In the present study, PCI procedural data recorded between January 2014 and December 2015 in the Japanese PCI registry, a nationwide registration system, were analyzed. Institutions and operators were categorized into deciles based on the number of PCIs performed per year. Odds ratios (ORs) for in-hospital mortality and the composite endpoint (in-hospital death and periprocedural complications) were estimated for each decile (with the lowest volume group as a reference group). Results A total of 323,322 PCIs (at 625 hospitals [median PCI cases/year: 216; quartiles: 121 to 332] by 4,211 operators [median PCI cases/year: 28; quartiles: 10 to 56]) were analyzed, of which 2,959 patients (0.9%) and 7,205 patients (2.2%) experienced in-hospital mortality and the composite endpoint after PCI, respectively. The adjusted risk for in-hospital mortality and the composite endpoint was significantly higher in hospitals included in the lowest decile (<150 PCIs/year); the risk remained consistently low across the remaining deciles. Contrastingly, no significant volume–outcome relationship was observed between operator volume and outcomes. A similar trend was observed when the analysis was confined to emergency/urgent PCI cases. Conclusions In contemporary Japanese PCI practice, lower institutional volume was related inversely to in-hospital outcomes, but the association of annual operator volume with outcomes was less clear.
AB - Objectives The aim of this study was to assess the volume–outcome relationship for PCI within the nationwide registration system in Japan. Background The effect of site and operator case load for percutaneous coronary intervention (PCI) on outcomes has not been investigated thoroughly in non-Western regions. Methods In the present study, PCI procedural data recorded between January 2014 and December 2015 in the Japanese PCI registry, a nationwide registration system, were analyzed. Institutions and operators were categorized into deciles based on the number of PCIs performed per year. Odds ratios (ORs) for in-hospital mortality and the composite endpoint (in-hospital death and periprocedural complications) were estimated for each decile (with the lowest volume group as a reference group). Results A total of 323,322 PCIs (at 625 hospitals [median PCI cases/year: 216; quartiles: 121 to 332] by 4,211 operators [median PCI cases/year: 28; quartiles: 10 to 56]) were analyzed, of which 2,959 patients (0.9%) and 7,205 patients (2.2%) experienced in-hospital mortality and the composite endpoint after PCI, respectively. The adjusted risk for in-hospital mortality and the composite endpoint was significantly higher in hospitals included in the lowest decile (<150 PCIs/year); the risk remained consistently low across the remaining deciles. Contrastingly, no significant volume–outcome relationship was observed between operator volume and outcomes. A similar trend was observed when the analysis was confined to emergency/urgent PCI cases. Conclusions In contemporary Japanese PCI practice, lower institutional volume was related inversely to in-hospital outcomes, but the association of annual operator volume with outcomes was less clear.
KW - complication
KW - in-hospital mortality
KW - percutaneous coronary intervention
KW - volume–outcome relationship
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U2 - 10.1016/j.jcin.2017.02.015
DO - 10.1016/j.jcin.2017.02.015
M3 - Article
C2 - 28473114
AN - SCOPUS:85018418811
VL - 10
SP - 918
EP - 927
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 9
ER -