Although many studies show an inverse association between operator procedural volume and short-term adverse outcomes after percutaneous coronary intervention (PCI), the association between procedural volume and longer term outcomes is unknown.
Using the National Cardiovascular Data Registry (NCDR) CathPCI registry data linked with Medicare claims data, we examined the association between operator PCI volume and long-term outcomes among patients aged ≥ 65 years. Operators were stratified by average annual PCI volume (counting PCIs performed in patients of all ages): low- (< 50 PCIs), intermediate- (50-100), and high-volume operators (> 100). One-year unadjusted rates of death and major adverse coronary events (MACE, defined as death, readmission for myocardial infarction [MI], or unplanned coronary revascularization) were calculated using Kaplan-Meier methods. The proportional hazards assumption was not met and risk-adjusted associations between operator volume and outcomes were calculated separately from the time of PCI to hospital discharge and from hospital discharge to 1-year follow-up.
Between July 1, 2009 and December 31, 2014, 723,644 PCI procedures were performed by 8,936 operators: 2,553 high-, 2,878 intermediate-, and 3,505 low-volume. Compared with high- and intermediate-volume operators, low-volume operators more often performed emergency PCI and their patients had fewer cardiovascular comorbidities. Over 1 year follow-up, 15.9% of patients treated by low-volume operators had a MACE event compared with 16.9% of patients treated by high-volume operators ( p = 0.004). After multivariable adjustment, intermediate- and high-volume operators had a significantly lower rate of in-hospital death than low-volume operators (OR 0.91, 95% CI 0.86-0.96 for intermediate vs. low; OR 0.79, 95% CI 0.75-0.83 for high vs. low). There were no significant differences in rates of MACE, death, MI, or unplanned revascularization between operator cohorts from hospital discharge to 1-year follow-up (adjusted HR for MACE: 0.99, 95% CI 0.96-1.01 for intermediate vs. low; HR 1.01, 95% CI 0.99-1.04 for high versus low).
Unadjusted 1-year outcomes following PCI were worse for older adults treated by operators with higher annual volume; however, patients treated by these operators had more cardiovascular comorbidities. After risk adjustment, higher operator volume was associated with lower in-hospital mortality and no difference in post-discharge MACE.
This research output has an Altmetric Attention Score of 27. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 May 2024.
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