Korean Circ J.  2020 Feb;50(2):133-144. 10.4070/kcj.2019.0206.

Effect of Operator Volume on In-Hospital Outcomes Following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Based on the 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

Affiliations
  • 1Division of Cardiovascular, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea. pjs@med.yu.ac.kr
  • 2Department of Preventive Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 3Division of Cardiology, National Health Insurance Service (NHIS) Ilsan Hospital, Goyang, Korea.
  • 4Heart Center, Konyang University Hospital, Daejeon, Korea.
  • 5Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea.
  • 6Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
  • 7Department of Cardiology, Myongji Hospital, Goyang, Korea.
  • 8Division of Cardiology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
  • 9Department of Cardiology, Inje University Busan Paik Hospital, Busan, Korea.
  • 10Division of Cardiovascular, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, Korea.
  • 11Department of Internal Medicine, Chungbuk National University, Cheongju, Korea. drcorazon@hanmail.net

Abstract

BACKGROUND AND OBJECTIVES
The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI.
METHODS
Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10-30 cases/year), and below the 25th percentile (<10 cases/year) were defined as high, moderate, and low-volume operators, respectively. In-hospital outcomes including mortality, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were analyzed.
RESULTS
The average number of primary PCI cases performed by 373 operators was 22.2 in a year. In-hospital mortality after PCI for STEMI was 571 cases (6.9%). In-hospital outcomes by operator volume showed no significant differences in the death rate, cardiac death, non-fatal MI, and stent thrombosis. However, the rate of urgent repeat PCI tended to be lower in the high-volume operator (0.6%) than in the moderate-(0.7%)/low-(1.5%) volume operator groups (p=0.095). The adjusted odds ratios for adverse in-hospital outcomes were similar in the 3 groups. Multivariate analysis also showed that operator volume was not a predictor for adverse in-hospital outcomes.
CONCLUSIONS
In-hospital outcomes after primary PCI for STEMI were not associated with operator volume in the K-PCI registry.

Keyword

ST elevation myocardial infarction; Percutaneous coronary intervention; Operator volume; Treatment outcome

MeSH Terms

Cohort Studies*
Death
Hospital Mortality
Humans
Mortality
Multivariate Analysis
Myocardial Infarction*
Odds Ratio
Percutaneous Coronary Intervention*
Retrospective Studies
Stents
Stroke
Thrombosis
Treatment Outcome

Figure

  • Figure 1 The geographic pattern of operator volume showed that the mean number of primary percutaneous coronary intervention cases was significantly higher in Honam province than other provinces. PCI = percutaneous coronary intervention.

  • Figure 2 (A) The adjusted OR for MACCE according to operator volume. (B) The adjusted OR for adverse in-hospital outcomes according to operator volume. We adjusted confounding factor, such as age, sex, hypertension, diabetes, family history of premature coronary artery disease, prior percutaneous coronary intervention, and renal failure. MACCE = major adverse cardiovascular and cerebrovascular event; OR = odds ratio.


Cited by  3 articles

Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry
Byong-Kyu Kim, Deuk-Young Nah, Kang Un Choi, Jun-Ho Bae, Moo-Yong Rhee, Jae-Sik Jang, Keon-Woong Moon, Jun-Hee Lee, Hee-Yeol Kim, Seung-Ho Kang, Woo hyuk Song, Seung Uk Lee, Byung-Ju Shim, Hangjae Chung, Min Su Hyon
Korean Circ J. 2020;50(11):1026-1036.    doi: 10.4070/kcj.2020.0172.

The Operator Volume of Primary Percutaneous Coronary Intervention for ST Segment Elevation Myocardial Infarction Does Not Guarantee Its Quality in Korea
Chang-Hwan Yoon
Korean Circ J. 2020;50(2):145-147.    doi: 10.4070/kcj.2019.0389.

Implementation of National Health Policy for the Prevention and Control of Cardiovascular Disease in South Korea: Regional-Local Cardio-Cerebrovascular Center and Nationwide Registry
Ju Mee Wang, Byung Ok Kim, Jang-Whan Bae, Dong-Jin Oh
Korean Circ J. 2021;51(5):383-398.    doi: 10.4070/kcj.2021.0001.


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