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 : 001098 ( Main/Exploration ); précédent : 001097; suivant : 001099Volume–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 [Allemagne] ; R. Dietz [Allemagne] ; K E Hauptmann ; E. Grube ; S. Kerber ; U. Sechtem [Allemagne]Source :
- Heart [ 1355-6037 ] ; 2008-03.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
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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.
Url:
DOI: 10.1136/hrt.2007.118737
Affiliations:
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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><wicri:noCountry code="subField">Nürnberg</wicri:noCountry></affiliation></author><author><name sortKey="Gottwik, M" sort="Gottwik, M" uniqKey="Gottwik M" first="M" last="Gottwik">M. Gottwik</name><affiliation><wicri:noCountry code="subField">Ludwigshafen</wicri:noCountry></affiliation></author><author><name sortKey="Hochadel, M" sort="Hochadel, M" uniqKey="Hochadel M" first="M" last="Hochadel">M. Hochadel</name><affiliation><wicri:noCountry code="subField">Ludwigshafen</wicri:noCountry></affiliation></author><author><name sortKey="Senges, J" sort="Senges, J" uniqKey="Senges J" first="J" last="Senges">J. Senges</name><affiliation></affiliation><affiliation><wicri:noCountry code="subField">Ludwigshafen</wicri:noCountry></affiliation></author><author><name sortKey="Zeymer, U" sort="Zeymer, U" uniqKey="Zeymer U" first="U" last="Zeymer">U. Zeymer</name><affiliation><wicri:noCountry code="subField">Ludwigshafen</wicri:noCountry></affiliation></author><author><name sortKey="Vogt, A" sort="Vogt, A" uniqKey="Vogt A" first="A" last="Vogt">A. Vogt</name><affiliation><wicri:noCountry code="subField">Kassel</wicri:noCountry></affiliation></author><author><name sortKey="Meinertz, T" sort="Meinertz, T" uniqKey="Meinertz T" first="T" last="Meinertz">T. 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Grube</name><affiliation><wicri:noCountry code="subField">Siegburg</wicri:noCountry></affiliation></author><author><name sortKey="Kerber, S" sort="Kerber, S" uniqKey="Kerber S" first="S" last="Kerber">S. Kerber</name><affiliation><wicri:noCountry code="subField">Neustadt/Saale</wicri:noCountry></affiliation></author><author><name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U" last="Sechtem">U. Sechtem</name><affiliation wicri:level="3"><country>Allemagne</country><placeName><settlement type="city">Stuttgart</settlement><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Stuttgart</region></placeName><wicri:orgArea>Robert Bosch Krankenhaus</wicri:orgArea></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><keywords scheme="KwdEn" xml:lang="en"><term>Angioplasty</term><term>Cardiology</term><term>Circulatory system</term><term>Coronary artery</term><term>Daily</term><term>Evolution</term><term>High risk</term><term>Human</term><term>Instrumentation therapy</term><term>Limit</term><term>Professional practice</term><term>Prognosis</term><term>Result</term><term>Volume</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Angioplastie</term><term>Appareil circulatoire</term><term>Artère coronaire</term><term>Cardiologie</term><term>Evolution</term><term>Homme</term><term>Limite</term><term>Pratique professionnelle</term><term>Pronostic</term><term>Quotidien</term><term>Risque élevé</term><term>Résultat</term><term>Traitement instrumental</term><term>Volume</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></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><affiliations><list><country><li>Allemagne</li></country><region><li>Bade-Wurtemberg</li><li>Berlin</li><li>District de Stuttgart</li><li>Hambourg</li></region><settlement><li>Berlin</li><li>Hambourg</li><li>Stuttgart</li></settlement></list><tree><noCountry><name sortKey="Gottwik, M" sort="Gottwik, M" uniqKey="Gottwik M" first="M" last="Gottwik">M. Gottwik</name><name sortKey="Grube, E" sort="Grube, E" uniqKey="Grube E" first="E" last="Grube">E. Grube</name><name sortKey="Hauptmann, K E" sort="Hauptmann, K E" uniqKey="Hauptmann K" first="K E" last="Hauptmann">K E Hauptmann</name><name sortKey="Hochadel, M" sort="Hochadel, M" uniqKey="Hochadel M" first="M" last="Hochadel">M. Hochadel</name><name sortKey="Kerber, S" sort="Kerber, S" uniqKey="Kerber S" first="S" last="Kerber">S. Kerber</name><name sortKey="Senges, J" sort="Senges, J" uniqKey="Senges J" first="J" last="Senges">J. Senges</name><name sortKey="Vogt, A" sort="Vogt, A" uniqKey="Vogt A" first="A" last="Vogt">A. Vogt</name><name sortKey="Zahn, R" sort="Zahn, R" uniqKey="Zahn R" first="R" last="Zahn">R. Zahn</name><name sortKey="Zeymer, U" sort="Zeymer, U" uniqKey="Zeymer U" first="U" last="Zeymer">U. Zeymer</name></noCountry><country name="Allemagne"><region name="Hambourg"><name sortKey="Meinertz, T" sort="Meinertz, T" uniqKey="Meinertz T" first="T" last="Meinertz">T. Meinertz</name></region><name sortKey="Dietz, R" sort="Dietz, R" uniqKey="Dietz R" first="R" last="Dietz">R. Dietz</name><name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U" last="Sechtem">U. Sechtem</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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