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 : 000577Volume-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 :
- Heart : (London 1996) [ 1355-6037 ] ; 2008.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
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.
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<s2>Siegburg</s2>
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<affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Robert Bosch Krankenhaus</s1>
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<sZ>12 aut.</sZ>
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<term>Coronary artery</term>
<term>Daily</term>
<term>Evolution</term>
<term>High risk</term>
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<front><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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<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>
</fC02>
<fC03 i1="01" i2="X" l="FRE"><s0>Volume</s0>
<s5>09</s5>
</fC03>
<fC03 i1="01" i2="X" l="ENG"><s0>Volume</s0>
<s5>09</s5>
</fC03>
<fC03 i1="01" i2="X" l="SPA"><s0>Volumen</s0>
<s5>09</s5>
</fC03>
<fC03 i1="02" i2="X" l="FRE"><s0>Pronostic</s0>
<s5>10</s5>
</fC03>
<fC03 i1="02" i2="X" l="ENG"><s0>Prognosis</s0>
<s5>10</s5>
</fC03>
<fC03 i1="02" i2="X" l="SPA"><s0>Pronóstico</s0>
<s5>10</s5>
</fC03>
<fC03 i1="03" i2="X" l="FRE"><s0>Evolution</s0>
<s5>11</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>Evolution</s0>
<s5>11</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Evolución</s0>
<s5>11</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Angioplastie</s0>
<s5>12</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Angioplasty</s0>
<s5>12</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Angioplastia</s0>
<s5>12</s5>
</fC03>
<fC03 i1="05" i2="X" l="FRE"><s0>Artère coronaire</s0>
<s5>13</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG"><s0>Coronary artery</s0>
<s5>13</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA"><s0>Arteria coronaria</s0>
<s5>13</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE"><s0>Quotidien</s0>
<s5>14</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG"><s0>Daily</s0>
<s5>14</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA"><s0>Cotidiano</s0>
<s5>14</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE"><s0>Pratique professionnelle</s0>
<s5>15</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG"><s0>Professional practice</s0>
<s5>15</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA"><s0>Práctica profesional</s0>
<s5>15</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE"><s0>Limite</s0>
<s5>16</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG"><s0>Limit</s0>
<s5>16</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA"><s0>Límite</s0>
<s5>16</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE"><s0>Risque élevé</s0>
<s5>17</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG"><s0>High risk</s0>
<s5>17</s5>
</fC03>
<fC03 i1="09" i2="X" l="SPA"><s0>Riesgo alto</s0>
<s5>17</s5>
</fC03>
<fC03 i1="10" i2="X" l="FRE"><s0>Homme</s0>
<s5>18</s5>
</fC03>
<fC03 i1="10" i2="X" l="ENG"><s0>Human</s0>
<s5>18</s5>
</fC03>
<fC03 i1="10" i2="X" l="SPA"><s0>Hombre</s0>
<s5>18</s5>
</fC03>
<fC03 i1="11" i2="X" l="FRE"><s0>Résultat</s0>
<s5>19</s5>
</fC03>
<fC03 i1="11" i2="X" l="ENG"><s0>Result</s0>
<s5>19</s5>
</fC03>
<fC03 i1="11" i2="X" l="SPA"><s0>Resultado</s0>
<s5>19</s5>
</fC03>
<fC03 i1="12" i2="X" l="FRE"><s0>Appareil circulatoire</s0>
<s5>20</s5>
</fC03>
<fC03 i1="12" i2="X" l="ENG"><s0>Circulatory system</s0>
<s5>20</s5>
</fC03>
<fC03 i1="12" i2="X" l="SPA"><s0>Aparato circulatorio</s0>
<s5>20</s5>
</fC03>
<fC03 i1="13" i2="X" l="FRE"><s0>Cardiologie</s0>
<s5>21</s5>
</fC03>
<fC03 i1="13" i2="X" l="ENG"><s0>Cardiology</s0>
<s5>21</s5>
</fC03>
<fC03 i1="13" i2="X" l="SPA"><s0>Cardiología</s0>
<s5>21</s5>
</fC03>
<fC03 i1="14" i2="X" l="FRE"><s0>Traitement instrumental</s0>
<s5>78</s5>
</fC03>
<fC03 i1="14" i2="X" l="ENG"><s0>Instrumentation therapy</s0>
<s5>78</s5>
</fC03>
<fC03 i1="14" i2="X" l="SPA"><s0>Tratamiento instrumental</s0>
<s5>78</s5>
</fC03>
<fN21><s1>084</s1>
</fN21>
<fN44 i1="01"><s1>OTO</s1>
</fN44>
<fN82><s1>OTO</s1>
</fN82>
</pA>
</standard>
</inist>
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