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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 : 000576 ( PascalFrancis/Curation ); précédent : 000575; suivant : 000577

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)

Auteurs : R. Zahn [Allemagne] ; M. Gottwik [Allemagne] ; M. Hochadel [Allemagne] ; J. Senges [Allemagne] ; U. Zeymer [Allemagne] ; A. Vogt [Allemagne] ; T. Meinertz [Allemagne] ; R. Dietz [Allemagne] ; K. E. Hauptmann [Allemagne] ; E. Grube [Allemagne] ; S. Kerber [Allemagne] ; U. Sechtem [Allemagne]

Source :

RBID : Pascal:08-0141721

Descripteurs français

English descriptors

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 PCls (n = 5754) or >325 PCls (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% Cl; 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.
pA  
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A03   1    @0 Heart : (Lond. 1996)
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A08 01  1  ENG  @1 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)
A11 01  1    @1 ZAHN (R.)
A11 02  1    @1 GOTTWIK (M.)
A11 03  1    @1 HOCHADEL (M.)
A11 04  1    @1 SENGES (J.)
A11 05  1    @1 ZEYMER (U.)
A11 06  1    @1 VOGT (A.)
A11 07  1    @1 MEINERTZ (T.)
A11 08  1    @1 DIETZ (R.)
A11 09  1    @1 HAUPTMANN (K. E.)
A11 10  1    @1 GRUBE (E.)
A11 11  1    @1 KERBER (S.)
A11 12  1    @1 SECHTEM (U.)
A14 01      @1 Klinikum Nürnberg Süd @2 Nürnberg @3 DEU @Z 1 aut.
A14 02      @1 Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg @2 Ludwigshafen @3 DEU @Z 2 aut. @Z 3 aut. @Z 4 aut.
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A14 04      @1 Burgfeld Krankenhaus @2 Kassel @3 DEU @Z 6 aut.
A14 05      @1 Universitätskrankenhaus Eppendorf @2 Hamburg @3 DEU @Z 7 aut.
A14 06      @1 Charité Universitätsmedizin @2 Berlin @3 DEU @Z 8 aut.
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A14 08      @1 Klinikum Siegburg GmbH @2 Siegburg @3 DEU @Z 10 aut.
A14 09      @1 Klinikum @2 Bad Neustadt/Saale @3 DEU @Z 11 aut.
A14 10      @1 Robert Bosch Krankenhaus @2 Stuttgart @3 DEU @Z 12 aut.
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C01 01    ENG  @0 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 PCls (n = 5754) or >325 PCls (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% Cl; 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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C03 05  X  ENG  @0 Coronary artery @5 13
C03 05  X  SPA  @0 Arteria coronaria @5 13
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N21       @1 084
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Pascal:08-0141721

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<country>Allemagne</country>
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<name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U." last="Sechtem">U. Sechtem</name>
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<term>Evolution</term>
<term>High risk</term>
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<term>Prognosis</term>
<term>Result</term>
<term>Volume</term>
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<keywords scheme="Pascal" xml:lang="fr">
<term>Volume</term>
<term>Pronostic</term>
<term>Evolution</term>
<term>Angioplastie</term>
<term>Artère coronaire</term>
<term>Quotidien</term>
<term>Pratique professionnelle</term>
<term>Limite</term>
<term>Risque élevé</term>
<term>Homme</term>
<term>Résultat</term>
<term>Appareil circulatoire</term>
<term>Cardiologie</term>
<term>Traitement instrumental</term>
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<div type="abstract" xml:lang="en">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 PCls (n = 5754) or >325 PCls (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% Cl; 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>
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<s0>1355-6037</s0>
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<fA05>
<s2>94</s2>
</fA05>
<fA06>
<s2>3</s2>
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<fA08 i1="01" i2="1" l="ENG">
<s1>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)</s1>
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<fA11 i1="02" i2="1">
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<fA11 i1="03" i2="1">
<s1>HOCHADEL (M.)</s1>
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<fA11 i1="04" i2="1">
<s1>SENGES (J.)</s1>
</fA11>
<fA11 i1="05" i2="1">
<s1>ZEYMER (U.)</s1>
</fA11>
<fA11 i1="06" i2="1">
<s1>VOGT (A.)</s1>
</fA11>
<fA11 i1="07" i2="1">
<s1>MEINERTZ (T.)</s1>
</fA11>
<fA11 i1="08" i2="1">
<s1>DIETZ (R.)</s1>
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<fA11 i1="09" i2="1">
<s1>HAUPTMANN (K. E.)</s1>
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<fA11 i1="10" i2="1">
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<fA11 i1="11" i2="1">
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<fA11 i1="12" i2="1">
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<fA14 i1="01">
<s1>Klinikum Nürnberg Süd</s1>
<s2>Nürnberg</s2>
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<sZ>1 aut.</sZ>
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<fA14 i1="02">
<s1>Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg</s1>
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<s3>DEU</s3>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
</fA14>
<fA14 i1="03">
<s1>Herzzentrum, Kardiologie</s1>
<s2>Ludwigshafen</s2>
<s3>DEU</s3>
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<sZ>5 aut.</sZ>
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<fA14 i1="04">
<s1>Burgfeld Krankenhaus</s1>
<s2>Kassel</s2>
<s3>DEU</s3>
<sZ>6 aut.</sZ>
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<fA14 i1="05">
<s1>Universitätskrankenhaus Eppendorf</s1>
<s2>Hamburg</s2>
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<sZ>7 aut.</sZ>
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<fA14 i1="06">
<s1>Charité Universitätsmedizin</s1>
<s2>Berlin</s2>
<s3>DEU</s3>
<sZ>8 aut.</sZ>
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<fA14 i1="07">
<s1>Krankenhaus der Barmherzigen Brüder</s1>
<s2>Trier</s2>
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<sZ>9 aut.</sZ>
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<fA14 i1="08">
<s1>Klinikum Siegburg GmbH</s1>
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<sZ>10 aut.</sZ>
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<fA14 i1="09">
<s1>Klinikum</s1>
<s2>Bad Neustadt/Saale</s2>
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<sZ>11 aut.</sZ>
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<fA14 i1="10">
<s1>Robert Bosch Krankenhaus</s1>
<s2>Stuttgart</s2>
<s3>DEU</s3>
<sZ>12 aut.</sZ>
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<fA20>
<s1>329-335</s1>
</fA20>
<fA21>
<s1>2008</s1>
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<s0>ENG</s0>
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<s1>INIST</s1>
<s2>3995</s2>
<s5>354000175101250230</s5>
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<s0>0000</s0>
<s1>© 2008 INIST-CNRS. All rights reserved.</s1>
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<fA45>
<s0>27 ref.</s0>
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<fA47 i1="01" i2="1">
<s0>08-0141721</s0>
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<fA60>
<s1>P</s1>
</fA60>
<fA61>
<s0>A</s0>
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<fA64 i1="01" i2="1">
<s0>Heart : (London 1996)</s0>
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<fA66 i1="01">
<s0>GBR</s0>
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<fC01 i1="01" l="ENG">
<s0>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 PCls (n = 5754) or >325 PCls (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% Cl; 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.</s0>
</fC01>
<fC02 i1="01" i2="X">
<s0>002B12</s0>
</fC02>
<fC02 i1="02" i2="X">
<s0>002B26E</s0>
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<s0>Volume</s0>
<s5>09</s5>
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<s0>Volume</s0>
<s5>09</s5>
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<s0>Volumen</s0>
<s5>09</s5>
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<s5>10</s5>
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<s5>10</s5>
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<fC03 i1="02" i2="X" l="SPA">
<s0>Pronóstico</s0>
<s5>10</s5>
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<s5>11</s5>
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<s0>Evolución</s0>
<s5>11</s5>
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<s0>Angioplastie</s0>
<s5>12</s5>
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<s5>13</s5>
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<s0>Arteria coronaria</s0>
<s5>13</s5>
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<s0>Quotidien</s0>
<s5>14</s5>
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<s0>Daily</s0>
<s5>14</s5>
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<s0>Cotidiano</s0>
<s5>14</s5>
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<s5>15</s5>
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<s5>15</s5>
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<s0>Práctica profesional</s0>
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<s0>Limite</s0>
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<s5>16</s5>
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<s0>Límite</s0>
<s5>16</s5>
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<s0>Risque élevé</s0>
<s5>17</s5>
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<s5>17</s5>
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<s0>Riesgo alto</s0>
<s5>17</s5>
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<s0>Homme</s0>
<s5>18</s5>
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<s5>18</s5>
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<s0>Hombre</s0>
<s5>18</s5>
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<fC03 i1="11" i2="X" l="FRE">
<s0>Résultat</s0>
<s5>19</s5>
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<s0>Result</s0>
<s5>19</s5>
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<s0>Resultado</s0>
<s5>19</s5>
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<s0>Appareil circulatoire</s0>
<s5>20</s5>
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<fC03 i1="12" i2="X" l="ENG">
<s0>Circulatory system</s0>
<s5>20</s5>
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<s0>Aparato circulatorio</s0>
<s5>20</s5>
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<s5>21</s5>
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<s5>21</s5>
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<s0>Cardiología</s0>
<s5>21</s5>
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<fC03 i1="14" i2="X" l="FRE">
<s0>Traitement instrumental</s0>
<s5>78</s5>
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<s0>Instrumentation therapy</s0>
<s5>78</s5>
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<s0>Tratamiento instrumental</s0>
<s5>78</s5>
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<s1>084</s1>
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<s1>OTO</s1>
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<s1>OTO</s1>
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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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