Association of Hospital Primary PCI Volume in Treatment Quality and Outcomes for STEMI Analyzed

November 25, 2009—Dharam J. Kumbhani, MD, et al, for the American Heart Association's Get With the Guideline's steering committee, published findings in the Journal of the American Medical Association (2009;302:2207–2213) from a study that sought to assess the relationship between hospital primary angioplasty volume and outcomes and quality-of-care measures in patients presenting with ST-segment elevation myocardial infarction (STEMI).<

According to the investigators, earlier studies indicate an inverse relationship between hospital volume and mortality after primary angioplasty for patients presenting with STEMI. However, contemporary data are lacking. This study was an observational analysis of data on 29,513 patients presenting with STEMI and undergoing primary angioplasty in the Get With the Guidelines registry. Patients were treated between July 5, 2001, and December 31, 2007, at 166 angioplasty-capable hospitals across the United States. Hospitals were divided into tertiles (< 36 procedures per year, 36–70 procedures per year, and > 70 procedures per year) based on their annual primary angioplasty volume.

The main outcome measures were door-to-balloon (DTB) times, length of hospital stay, adherence with evidence-based quality-of-care measures, and in-hospital mortality.

The investigators reported that compared with low- and medium-volume centers, high-volume centers had better median DTB times (98 vs 90 vs 88 minutes, respectively; P for trend < .001). High-volume centers were more likely than low-volume centers to follow evidence-based guidelines at discharge. Length of stay was similar between the three groups (P for trend = .13). There was no significant difference in the crude mortality between the tertiles of volume (incidence rate, 3.9% vs 3.2% vs 3% for low-, medium-, and high-volume centers, respectively; P = .26; and P = .99 for low- and medium-volume hospitals vs high-volume hospitals). Sequential multivariable modeling using generalized estimating equations revealed no significant association between hospital primary angioplasty volume and in-hospital mortality (adjusted odds ratio, 1.22; 95% confidence interval, 0.78–1.91; P = .38 and adjusted odds ratio, 1.14; 95% confidence interval, 0.78–1.66; P = .49 for low- and medium- vs high-volume hospitals, respectively).

In this contemporary registry of patients with STEMI, higher-volume primary angioplasty centers versus lower-volume centers were associated with shorter DTB times and more use of evidence-based therapies but not with adjusted in-hospital mortality or length of hospital stay, the investigators concluded.