Volume–outcomes relationship in the Era of modern coronary intervention—results from the prospective multicenter German DES.DE Registry. Issue 6 (14th June 2013)

• Record Type: Journal Article
• Authors: Akin, Ibrahim; Hochadel, Mathias; Schneider, Steffen; Abdel‐Wahab, Mohamed; Zahn, Ralf; Senges, Jochen; Richardt, Gert; Kuck, Karl‐Heinz; Nienaber, Christoph A.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 82:Issue 6(2013:Nov. 15)
• Page Start: E788
• Page End: E797
• Publication Date: 2013-06-14
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.24986
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd24986-sec-0001" sec-type="section"> <title>Objective</title> <p>We compare clinical outcomes among unselected patients undergoing percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) stratified in categories of treating hospital PCI volume.</p> </sec> <sec id="ccd24986-sec-0002" sec-type="section"> <title>Background</title> <p>Previous observational evidence suggests an inverse relation between hospital volume and patients' outcomes. However, there are no mid‐term outcomes data with the use of DES.</p> </sec> <sec id="ccd24986-sec-0003" sec-type="section"> <title>Methods</title> <p>We used data from DES.DE (German Drug‐Eluting Stent) registry to compare in‐hospital and 1‐year outcomes among unselected patients. Primary endpoints at one year follow‐up were the rate of major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR).</p> </sec> <sec id="ccd24986-sec-0004" sec-type="section"> <title>Results</title> <p>Between 2005 and 2006, 2, 075 patients were treated in group I hospitals (<1, 000 PCIs/year), 1, 624 in group II hospitals (1, 000–1, 500 PCIs/year), and 1, 790 in group III hospitals (>1, 500 PCIs/year). Compared with group II and group III, group I allocation was associated with higher rates of overall hospital mortality (1.1% versus 0.2% versus 0.2%; <italic>P</italic> < 0.0001) and severe bleeding (1.0% versus 0.4% versus 0.5%; <italic>P</italic> < 0.05); similarly, poorer outcomes with respect to MACCE (7.2% versus 6.5% versus 4.7%; <italic>P</italic> < 0.01), stent thrombosis (5.2% versus 5.0% versus 3.0%; <italic>P</italic> < 0.01), and non‐fatal stroke (1.5% versus 0.9% versus 0.7%; <italic>P</italic> < 0.05) were documented in group I. Conversely, TVR rates were highest in group II (10.2% versus 14.2% versus 11.7%; <italic>P</italic> < 0.01); these differences persisted after risk adjustment for heterogeneous baseline characteristics.</p> </sec> <sec id="ccd24986-sec-0005" sec-type="section"> <title>Conclusions</title> <p>In the era of modern coronary intervention technological advances such as DES have not offset the inverse relation between procedural volume and both in‐hospital and 1‐year outcomes after PCI. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>