Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)
Identifieur interne : 001B78 ( Istex/Corpus ); précédent : 001B77; suivant : 001B79Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)
Auteurs : R. Zahn ; M. Gottwik ; M. Hochadel ; J. Senges ; U. Zeymer ; A. Vogt ; T. Meinertz ; R. Dietz ; K E Hauptmann ; E. Grube ; S. Kerber ; U. SechtemSource :
- Heart [ 1355-6037 ] ; 2008-03.
Abstract
Objective: The formerly observed volume–outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned. Design: We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Patients: In 2003 a total of 27 965 patients at 67 hospitals were included. Results: The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction. Conclusions: This analysis of contemporary PCI in clinical practice shows a small but significant volume–outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.
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DOI: 10.1136/hrt.2007.118737
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)</title><author><name sortKey="Zahn, R" sort="Zahn, R" uniqKey="Zahn R" first="R" last="Zahn">R. Zahn</name><affiliation><mods:affiliation>Klinikum Nürnberg Süd, Nürnberg</mods:affiliation></affiliation></author><author><name sortKey="Gottwik, M" sort="Gottwik, M" uniqKey="Gottwik M" first="M" last="Gottwik">M. Gottwik</name><affiliation><mods:affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Hochadel, M" sort="Hochadel, M" uniqKey="Hochadel M" first="M" last="Hochadel">M. Hochadel</name><affiliation><mods:affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Senges, J" sort="Senges, J" uniqKey="Senges J" first="J" last="Senges">J. Senges</name><affiliation><mods:affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</mods:affiliation></affiliation><affiliation><mods:affiliation>Herzzentrum, Kardiologie, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Zeymer, U" sort="Zeymer, U" uniqKey="Zeymer U" first="U" last="Zeymer">U. Zeymer</name><affiliation><mods:affiliation>Herzzentrum, Kardiologie, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Vogt, A" sort="Vogt, A" uniqKey="Vogt A" first="A" last="Vogt">A. Vogt</name><affiliation><mods:affiliation>Burgfeld Krankenhaus, Kassel</mods:affiliation></affiliation></author><author><name sortKey="Meinertz, T" sort="Meinertz, T" uniqKey="Meinertz T" first="T" last="Meinertz">T. Meinertz</name><affiliation><mods:affiliation>Universitätskrankenhaus Eppendorf, Hamburg</mods:affiliation></affiliation></author><author><name sortKey="Dietz, R" sort="Dietz, R" uniqKey="Dietz R" first="R" last="Dietz">R. Dietz</name><affiliation><mods:affiliation>Charité Universitätsmedizin, Berlin</mods:affiliation></affiliation></author><author><name sortKey="Hauptmann, K E" sort="Hauptmann, K E" uniqKey="Hauptmann K" first="K E" last="Hauptmann">K E Hauptmann</name><affiliation><mods:affiliation>Krankenhaus der Barmherzigen Brüder, Trier</mods:affiliation></affiliation></author><author><name sortKey="Grube, E" sort="Grube, E" uniqKey="Grube E" first="E" last="Grube">E. Grube</name><affiliation><mods:affiliation>Klinikum Siegburg GmbH, Siegburg</mods:affiliation></affiliation></author><author><name sortKey="Kerber, S" sort="Kerber, S" uniqKey="Kerber S" first="S" last="Kerber">S. Kerber</name><affiliation><mods:affiliation>Klinikum, Bad Neustadt/Saale</mods:affiliation></affiliation></author><author><name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U" last="Sechtem">U. Sechtem</name><affiliation><mods:affiliation>Robert Bosch Krankenhaus, Stuttgart</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF</idno><date when="2008" year="2008">2008</date><idno type="doi">10.1136/hrt.2007.118737</idno><idno type="url">https://api.istex.fr/document/B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001B78</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001B78</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)</title><author><name sortKey="Zahn, R" sort="Zahn, R" uniqKey="Zahn R" first="R" last="Zahn">R. Zahn</name><affiliation><mods:affiliation>Klinikum Nürnberg Süd, Nürnberg</mods:affiliation></affiliation></author><author><name sortKey="Gottwik, M" sort="Gottwik, M" uniqKey="Gottwik M" first="M" last="Gottwik">M. Gottwik</name><affiliation><mods:affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Hochadel, M" sort="Hochadel, M" uniqKey="Hochadel M" first="M" last="Hochadel">M. Hochadel</name><affiliation><mods:affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Senges, J" sort="Senges, J" uniqKey="Senges J" first="J" last="Senges">J. Senges</name><affiliation><mods:affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</mods:affiliation></affiliation><affiliation><mods:affiliation>Herzzentrum, Kardiologie, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Zeymer, U" sort="Zeymer, U" uniqKey="Zeymer U" first="U" last="Zeymer">U. Zeymer</name><affiliation><mods:affiliation>Herzzentrum, Kardiologie, Ludwigshafen</mods:affiliation></affiliation></author><author><name sortKey="Vogt, A" sort="Vogt, A" uniqKey="Vogt A" first="A" last="Vogt">A. Vogt</name><affiliation><mods:affiliation>Burgfeld Krankenhaus, Kassel</mods:affiliation></affiliation></author><author><name sortKey="Meinertz, T" sort="Meinertz, T" uniqKey="Meinertz T" first="T" last="Meinertz">T. Meinertz</name><affiliation><mods:affiliation>Universitätskrankenhaus Eppendorf, Hamburg</mods:affiliation></affiliation></author><author><name sortKey="Dietz, R" sort="Dietz, R" uniqKey="Dietz R" first="R" last="Dietz">R. Dietz</name><affiliation><mods:affiliation>Charité Universitätsmedizin, Berlin</mods:affiliation></affiliation></author><author><name sortKey="Hauptmann, K E" sort="Hauptmann, K E" uniqKey="Hauptmann K" first="K E" last="Hauptmann">K E Hauptmann</name><affiliation><mods:affiliation>Krankenhaus der Barmherzigen Brüder, Trier</mods:affiliation></affiliation></author><author><name sortKey="Grube, E" sort="Grube, E" uniqKey="Grube E" first="E" last="Grube">E. Grube</name><affiliation><mods:affiliation>Klinikum Siegburg GmbH, Siegburg</mods:affiliation></affiliation></author><author><name sortKey="Kerber, S" sort="Kerber, S" uniqKey="Kerber S" first="S" last="Kerber">S. Kerber</name><affiliation><mods:affiliation>Klinikum, Bad Neustadt/Saale</mods:affiliation></affiliation></author><author><name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U" last="Sechtem">U. Sechtem</name><affiliation><mods:affiliation>Robert Bosch Krankenhaus, Stuttgart</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Heart</title><title level="j" type="abbrev">Heart</title><idno type="ISSN">1355-6037</idno><idno type="eISSN">1468-201X</idno><imprint><publisher>BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><date type="published" when="2008-03">2008-03</date><biblScope unit="volume">94</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="329">329</biblScope></imprint><idno type="ISSN">1355-6037</idno></series><idno type="istex">B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF</idno><idno type="DOI">10.1136/hrt.2007.118737</idno><idno type="href">heartjnl-94-329.pdf</idno><idno type="ArticleID">ht118737</idno><idno type="PMID">17664190</idno><idno type="local">heartjnl;94/3/329</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1355-6037</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective: The formerly observed volume–outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned. Design: We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Patients: In 2003 a total of 27 965 patients at 67 hospitals were included. Results: The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction. Conclusions: This analysis of contemporary PCI in clinical practice shows a small but significant volume–outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>R Zahn</name><affiliations><json:string>Klinikum Nürnberg Süd, Nürnberg</json:string></affiliations></json:item><json:item><name>M Gottwik</name><affiliations><json:string>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</json:string></affiliations></json:item><json:item><name>M Hochadel</name><affiliations><json:string>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</json:string></affiliations></json:item><json:item><name>J Senges</name><affiliations><json:string>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</json:string><json:string>Herzzentrum, Kardiologie, Ludwigshafen</json:string></affiliations></json:item><json:item><name>U Zeymer</name><affiliations><json:string>Herzzentrum, Kardiologie, Ludwigshafen</json:string></affiliations></json:item><json:item><name>A Vogt</name><affiliations><json:string>Burgfeld Krankenhaus, Kassel</json:string></affiliations></json:item><json:item><name>T Meinertz</name><affiliations><json:string>Universitätskrankenhaus Eppendorf, Hamburg</json:string></affiliations></json:item><json:item><name>R Dietz</name><affiliations><json:string>Charité Universitätsmedizin, Berlin</json:string></affiliations></json:item><json:item><name>K E Hauptmann</name><affiliations><json:string>Krankenhaus der Barmherzigen Brüder, Trier</json:string></affiliations></json:item><json:item><name>E Grube</name><affiliations><json:string>Klinikum Siegburg GmbH, Siegburg</json:string></affiliations></json:item><json:item><name>S Kerber</name><affiliations><json:string>Klinikum, Bad Neustadt/Saale</json:string></affiliations></json:item><json:item><name>U Sechtem</name><affiliations><json:string>Robert Bosch Krankenhaus, Stuttgart</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Drugs: cardiovascular system</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Interventional cardiology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Acute coronary syndromes</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Percutaneous intervention</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Epidemiology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>coronary angioplasty</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>risk</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>volume–outcome relation</value></json:item></subject><articleId><json:string>ht118737</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective: The formerly observed volume–outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned. Design: We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Patients: In 2003 a total of 27 965 patients at 67 hospitals were included. Results: The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend >0.001). Two groups of patients were then compared according to their treatment at hospitals with either >325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction. Conclusions: This analysis of contemporary PCI in clinical practice shows a small but significant volume–outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.</abstract><qualityIndicators><score>9.101</score><pdfVersion>1.2</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>8</keywordCount><abstractCharCount>1394</abstractCharCount><pdfWordCount>4713</pdfWordCount><pdfCharCount>34153</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>199</abstractWordCount></qualityIndicators><title>Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? 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Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte.</title></json:item><json:item><author><json:item><name>DJ Magid</name></json:item><json:item><name>BN Calonge</name></json:item><json:item><name>JS Rumsfeld</name></json:item></author><host><volume>284</volume><author></author><title>JAMA</title></host><title>Relation between hospital primary angioplasty volume and mortality for patients with acute MI treated with primary angioplasty vs thrombolytic therapy.</title></json:item></refBibs><genre><json:string>research-article</json:string></genre><host><volume>94</volume><publisherId><json:string>hrt</json:string></publisherId><pages><first>329</first></pages><issn><json:string>1355-6037</json:string></issn><issue>3</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1468-201X</json:string></eissn><title>Heart</title></host><categories><wos><json:string>science</json:string><json:string>cardiac & cardiovascular systems</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>cardiovascular system & hematology</json:string></scienceMetrix></categories><publicationDate>2008</publicationDate><copyrightDate>2008</copyrightDate><doi><json:string>10.1136/hrt.2007.118737</json:string></doi><id>B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF</id><score>0.29851308</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><availability><p>2008 BMJ Publishing Group and British Cardiac Society</p></availability><date>2007-07-30</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)</title><author xml:id="author-1"><persName><forename type="first">R</forename><surname>Zahn</surname></persName><affiliation>Klinikum Nürnberg Süd, Nürnberg</affiliation></author><author xml:id="author-2"><persName><forename type="first">M</forename><surname>Gottwik</surname></persName><affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</affiliation></author><author xml:id="author-3"><persName><forename type="first">M</forename><surname>Hochadel</surname></persName><affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</affiliation></author><author xml:id="author-4"><persName><forename type="first">J</forename><surname>Senges</surname></persName><affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</affiliation><affiliation>Herzzentrum, Kardiologie, Ludwigshafen</affiliation></author><author xml:id="author-5"><persName><forename type="first">U</forename><surname>Zeymer</surname></persName><affiliation>Herzzentrum, Kardiologie, Ludwigshafen</affiliation></author><author xml:id="author-6"><persName><forename type="first">A</forename><surname>Vogt</surname></persName><affiliation>Burgfeld Krankenhaus, Kassel</affiliation></author><author xml:id="author-7"><persName><forename type="first">T</forename><surname>Meinertz</surname></persName><affiliation>Universitätskrankenhaus Eppendorf, Hamburg</affiliation></author><author xml:id="author-8"><persName><forename type="first">R</forename><surname>Dietz</surname></persName><affiliation>Charité Universitätsmedizin, Berlin</affiliation></author><author xml:id="author-9"><persName><forename type="first">K E</forename><surname>Hauptmann</surname></persName><affiliation>Krankenhaus der Barmherzigen Brüder, Trier</affiliation></author><author xml:id="author-10"><persName><forename type="first">E</forename><surname>Grube</surname></persName><affiliation>Klinikum Siegburg GmbH, Siegburg</affiliation></author><author xml:id="author-11"><persName><forename type="first">S</forename><surname>Kerber</surname></persName><affiliation>Klinikum, Bad Neustadt/Saale</affiliation></author><author xml:id="author-12"><persName><forename type="first">U</forename><surname>Sechtem</surname></persName><affiliation>Robert Bosch Krankenhaus, Stuttgart</affiliation></author></analytic><monogr><title level="j">Heart</title><title level="j" type="abbrev">Heart</title><idno type="pISSN">1355-6037</idno><idno type="eISSN">1468-201X</idno><imprint><publisher>BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><date type="published" when="2008-03"></date><biblScope unit="volume">94</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="329">329</biblScope></imprint></monogr><idno type="istex">B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF</idno><idno type="DOI">10.1136/hrt.2007.118737</idno><idno type="href">heartjnl-94-329.pdf</idno><idno type="ArticleID">ht118737</idno><idno type="PMID">17664190</idno><idno type="local">heartjnl;94/3/329</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2007-07-30</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objective: The formerly observed volume–outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned. Design: We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Patients: In 2003 a total of 27 965 patients at 67 hospitals were included. Results: The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction. Conclusions: This analysis of contemporary PCI in clinical practice shows a small but significant volume–outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Drugs: cardiovascular system</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Interventional cardiology</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Acute coronary syndromes</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Percutaneous intervention</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Epidemiology</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>coronary angioplasty</term></item><item><term>risk</term></item><item><term>volume–outcome relation</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2007-07-30">Created</change><change when="2008-03">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">heartjnl</journal-id><journal-id journal-id-type="nlm-ta">Heart</journal-id><journal-id journal-id-type="publisher-id">hrt</journal-id><journal-title>Heart</journal-title><abbrev-journal-title abbrev-type="publisher">Heart</abbrev-journal-title><issn pub-type="ppub">1355-6037</issn><issn pub-type="epub">1468-201X</issn><publisher><publisher-name>BMJ Publishing Group Ltd and British Cardiovascular Society</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">ht118737</article-id><article-id pub-id-type="doi">10.1136/hrt.2007.118737</article-id><article-id pub-id-type="other">heartjnl;94/3/329</article-id><article-id pub-id-type="other">heartjnl;hrt.2007.118737</article-id><article-id pub-id-type="pmid">17664190</article-id><article-id pub-id-type="other">329</article-id><article-id pub-id-type="other">hrt.2007.118737</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original research</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Drugs: cardiovascular system</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Interventional cardiology</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Acute coronary syndromes</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Percutaneous intervention</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Epidemiology</subject></subj-group><series-title>Interventional cardiology</series-title></article-categories><title-group><article-title>Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)</article-title><alt-title alt-title-type="running-head">Interventional cardiology</alt-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Zahn</surname><given-names>R</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Gottwik</surname><given-names>M</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hochadel</surname><given-names>M</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Senges</surname><given-names>J</given-names></name><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Zeymer</surname><given-names>U</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Vogt</surname><given-names>A</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Meinertz</surname><given-names>T</given-names></name><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Dietz</surname><given-names>R</given-names></name><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hauptmann</surname><given-names>K E</given-names></name><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Grube</surname><given-names>E</given-names></name><xref ref-type="aff" rid="aff8">8</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kerber</surname><given-names>S</given-names></name><xref ref-type="aff" rid="aff9">9</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Sechtem</surname><given-names>U</given-names></name><xref ref-type="aff" rid="aff10">10</xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Klinikum Nürnberg Süd, Nürnberg</addr-line> </aff><aff id="aff2"><label>2</label><addr-line>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</addr-line> </aff><aff id="aff3"><label>3</label><addr-line>Herzzentrum, Kardiologie, Ludwigshafen</addr-line> </aff><aff id="aff4"><label>4</label><addr-line>Burgfeld Krankenhaus, Kassel</addr-line> </aff><aff id="aff5"><label>5</label><addr-line>Universitätskrankenhaus Eppendorf, Hamburg</addr-line> </aff><aff id="aff6"><label>6</label><addr-line>Charité Universitätsmedizin, Berlin</addr-line> </aff><aff id="aff7"><label>7</label><addr-line>Krankenhaus der Barmherzigen Brüder, Trier</addr-line> </aff><aff id="aff8"><label>8</label><addr-line>Klinikum Siegburg GmbH, Siegburg</addr-line> </aff><aff id="aff9"><label>9</label><addr-line>Klinikum, Bad Neustadt/Saale</addr-line> </aff><aff id="aff10"><label>10</label><addr-line>Robert Bosch Krankenhaus, Stuttgart</addr-line> </aff><author-notes><corresp>Priv.-Doz. Dr. med. Ralf Zahn, Med. Klinik 8, Kardiologie/Angiologie/Internistische Intensivmedizin, Klinikum Nürnberg, Breslauer Straße 201, 90471 Nürnberg; <email xlink:type="simple">erzahn@aol.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>3</month><year>2008</year></pub-date><pub-date pub-type="epub-original"><day>30</day><month>7</month><year>2007</year></pub-date><pub-date pub-type="epub"><day>30</day><month>7</month><year>2007</year></pub-date><volume>94</volume><volume-id pub-id-type="other">94</volume-id><volume-id pub-id-type="other">94</volume-id><issue>3</issue><issue-id pub-id-type="other">heartjnl;94/3</issue-id><issue-id pub-id-type="other">3</issue-id><issue-id pub-id-type="other">94/3</issue-id><fpage>329</fpage><history><date date-type="accepted"><day>19</day><month>6</month><year>2007</year></date></history><permissions><copyright-statement>2008 BMJ Publishing Group and British Cardiac Society</copyright-statement><copyright-year>2008</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="heartjnl-94-329.pdf"></self-uri><abstract><sec><title>Objective:</title><p>The formerly observed volume–outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned.</p></sec><sec><title>Design:</title><p>We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte.</p></sec><sec><title>Patients:</title><p>In 2003 a total of 27 965 patients at 67 hospitals were included.</p></sec><sec><title>Results:</title><p>The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction.</p></sec><sec><title>Conclusions:</title><p>This analysis of contemporary PCI in clinical practice shows a small but significant volume–outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.</p></sec></abstract><kwd-group><kwd>coronary angioplasty</kwd><kwd>risk</kwd><kwd>volume–outcome relation</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)</title><partName>Interventional cardiology</partName></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)</title><partName>Interventional cardiology</partName></titleInfo><name type="personal"><namePart type="given">R</namePart><namePart type="family">Zahn</namePart><affiliation>Klinikum Nürnberg Süd, Nürnberg</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M</namePart><namePart type="family">Gottwik</namePart><affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M</namePart><namePart type="family">Hochadel</namePart><affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J</namePart><namePart type="family">Senges</namePart><affiliation>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen</affiliation><affiliation>Herzzentrum, Kardiologie, Ludwigshafen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">U</namePart><namePart type="family">Zeymer</namePart><affiliation>Herzzentrum, Kardiologie, Ludwigshafen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Vogt</namePart><affiliation>Burgfeld Krankenhaus, Kassel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">T</namePart><namePart type="family">Meinertz</namePart><affiliation>Universitätskrankenhaus Eppendorf, Hamburg</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R</namePart><namePart type="family">Dietz</namePart><affiliation>Charité Universitätsmedizin, Berlin</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K E</namePart><namePart type="family">Hauptmann</namePart><affiliation>Krankenhaus der Barmherzigen Brüder, Trier</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E</namePart><namePart type="family">Grube</namePart><affiliation>Klinikum Siegburg GmbH, Siegburg</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Kerber</namePart><affiliation>Klinikum, Bad Neustadt/Saale</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">U</namePart><namePart type="family">Sechtem</namePart><affiliation>Robert Bosch Krankenhaus, Stuttgart</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>Drugs: cardiovascular system</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Interventional cardiology</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Acute coronary syndromes</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Percutaneous intervention</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Epidemiology</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><dateIssued encoding="w3cdtf">2008-03</dateIssued><dateCreated encoding="w3cdtf">2007-07-30</dateCreated><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Objective: The formerly observed volume–outcome relation for percutaneous coronary interventions (PCIs) has recently been questioned. Design: We analysed data of the PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte. Patients: In 2003 a total of 27 965 patients at 67 hospitals were included. Results: The median PCI volume per hospital was 327. In-hospital mortality was 1.85% in hospitals belonging to the lowest PCI volume quartile and 1.21% in the highest quartile (p for trend <0.001). Two groups of patients were then compared according to their treatment at hospitals with either <325 PCIs (n = 5754) or >325 PCIs (n = 22 211) per year. Logistic regression analysis showed that a PCI performed at hospitals with a volume of >325 PCI/year was independently associated with a lower hospital mortality (OR = 0.67, 95% CI: 0.52 to 0.87; p = 0.002). If PCI was performed in patients with acute myocardial infarction there was a significant decline in mortality with increasing volume (p for trend = 0.004); however, there was no association in patients without a myocardial infarction. Conclusions: This analysis of contemporary PCI in clinical practice shows a small but significant volume–outcome relation for in-hospital mortality. However, this relation was only apparent in high-risk subgroups, such as patients presenting with acute myocardial infarction.</abstract><subject><genre>keywords</genre><topic>coronary angioplasty</topic><topic>risk</topic><topic>volume–outcome relation</topic></subject><relatedItem type="host"><titleInfo><title>Heart</title></titleInfo><titleInfo type="abbreviated"><title>Heart</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1355-6037</identifier><identifier type="eISSN">1468-201X</identifier><identifier type="PublisherID">hrt</identifier><identifier type="PublisherID-hwp">heartjnl</identifier><identifier type="PublisherID-nlm-ta">Heart</identifier><part><date>2008</date><detail type="volume"><caption>vol.</caption><number>94</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>329</start></extent></part></relatedItem><identifier type="istex">B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF</identifier><identifier type="DOI">10.1136/hrt.2007.118737</identifier><identifier type="href">heartjnl-94-329.pdf</identifier><identifier type="ArticleID">ht118737</identifier><identifier type="PMID">17664190</identifier><identifier type="local">heartjnl;94/3/329</identifier><accessCondition type="use and reproduction" contentType="copyright">2008 BMJ Publishing Group and British Cardiac Society</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource></recordInfo></mods></metadata><annexes><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/document/B9F8ADCA6AD9D9AE8659E6E06FE4C6D63637D7DF/annexes/jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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|texte= Volume–outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)
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