Health Policy Manag.  2018 Jun;28(2):168-177. 10.4332/KJHPA.2018.28.2.168.

The Association of Hospital Volume of Percutaneous Coronary Intervention with Cardiac Mortality

• Kim JH
• Kim JM
• Park EC

• KMID: 2416655
• DOI: http://doi.org/10.4332/KJHPA.2018.28.2.168

Abstract

BACKGROUND
This study investigates the potential volume and outcome association of coronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) using a large and representative sample.
METHODS
We used a National Health Insurance Service-Cohort Sample Database from 2002 to 2013 released by the Korean National Health Insurance Service. A total of 8,908 subjects were analyzed. The primary analysis was based on Cox proportional hazards models to examine our hypothesis.
RESULTS
After adjusting for confounders, the hazard ratio of thirty-day and 1-year mortality in hospitals with a low volume of CHD patients with PCI was 2.8 and 2.2 times higher (p=0.00) compared to hospitals with a high volume of CHD patients with PCI, respectively. Thirty-day and 1-year mortality of CHD patients with PCI in low-volume hospitals admitted through the emergency room were 3.101 (p=0.00) and 2.8 times higher (p=0.01) than those in high-volume hospitals, respectively. Only 30-day mortality in low-volume hospitals of angina pectoris and myocardial infarction patients with PCI was 5.3 and 2.4 times those in high-volume hospitals with PCI, respectively.
CONCLUSION
Mortality was significantly lower when PCI was performed in a high-volume hospital than in a low-volume hospital. Among patients admitted through the emergency room and diagnosed with angina pectoris, total PCI volume (low vs. high) was associated with significantly greater cardiac mortality risk of CHD patients. Thus, There is a need for better strategic approaches from both clinical and health policy standpoints for treatment of CHD patients.

Keyword

Coronary heart disease; Mortality; Percutaneous coronary intervention

MeSH Terms

Angina Pectoris
Coronary Disease
Emergency Service, Hospital
Health Policy
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Mortality*
Myocardial Infarction
National Health Programs
Percutaneous Coronary Intervention*
Proportional Hazards Models