Study Shows Consistently Good Quality of PCI Procedures Across United States
November 12, 2017—The American Heart Association (AHA) announced findings from a study showing that patients undergoing percutaneous coronary intervention (PCI) for blocked or narrowed arteries appear to fare equally well at hospitals ranked among the best in heart care by US News and World Report and at unranked hospitals. The findings were delivered as a poster presentation at the AHA 2017 scientific sessions held November 11 to 15 in Anaheim, California.
The study's lead author is Devraj Sukul, MD, who is a cardiology fellow at the University of Michigan in Ann Arbor, Michigan, which is one of the top-ranked hospitals for PCI. In the AHA announcement, Dr. Sukul commented, "Previous studies have found that top-ranked hospitals generally performed better than nonranked hospitals for many cardiovascular conditions. However, due to significant quality improvement initiatives aimed at improving PCI outcomes, along with advances in pharmacologic and technical aspects of PCI care, we wanted to see if many more hospitals around the United States were performing safe and high-quality PCI.”
As explained in the AHA press release, investigators based their comparison of PCI results at ranked and unranked hospitals on patient information and PCI outcomes submitted to the National Cardiovascular Data Registry CathPCI. They reviewed the results of 509,153 angioplasties performed between July 2014 and June 2015 at 654 hospitals (six hospitals ranked among the top 50 by US News and World Report in 2015 were not included in this study because they either did not submit data to the registry or performed a low number of PCIs, making comparisons difficult).
The study found that ranked and unranked hospitals had similar rates of in-hospital deaths (< 2%) and similar rates of acute kidney injury and bleeding, which are two of the most common complications of PCI, which can increase a patient’s risk of dying, hamper recovery, and lead to longer hospital stays and increased hospital costs. The study also found that only 1% to 3% of PCIs performed at all the hospitals in the registry were classified as inappropriate.
Dr. Sukul explained, “In real-life clinical practice, there are many factors to be considered when deciding whether a patient will benefit from PCI. As always, the best way for patients to ensure they get the best treatment is to be actively engaged in their own health care by communicating openly with their physicians and asking questions.” He noted that patients needing PCI should be reassured that nonranked hospitals had similar outcomes as ranked hospitals in performing the procedure, adding, “Safe and appropriate PCI is performed across the nation in hospitals participating in this registry and meeting minimum volume targets.”
Study limitations include that not all hospitals performing PCI participated in the registry. The study also looked at only one heart procedure, so its findings cannot be generalized to other heart problems and treatments, advised the AHA announcement.