Korean Circ J.  2020 Nov;50(11):1026-1036. 10.4070/kcj.2020.0172.

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

• Kim BK
• Nah DY
• Choi KU
• Bae JH
• Rhee MY
• Jang JS
• Moon KW
• Lee JH
• Kim HY
• Kang SH
• Song Wh
• Lee SU
• Shim BJ
• Chung Hj
• Hyon MS

• KMID: 2508288
• DOI: http://doi.org/10.4070/kcj.2020.0172

Abstract

Background and Objectives
The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes.
Methods
We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI.
Results
Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE.
Conclusions
Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.

Keyword

Myocardial infarction; Percutaneous coronary intervention; Low-volume hospitals; Treatment outcome

Figure

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  Figure 1 In-hospital outcomes by PCI volume.MACCE = major adverse cardiovascular and cerebrovascular events; MI = myocardial infarction; NS = not significant; PCI = percutaneous coronary intervention.

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  Figure 2 Odds ratios of major adverse cardiovascular and cerebrovascular events.CARDIAC_ARREST = cardiac arrest; CARDIO_SHOCK = cardiogenic shock; CVD = cerebrovascular disease; DM = diabetes mellitus; DxSTEMI = diagnosis of ST-segment elevation myocardial infarction; IVUS = intravascular ultrasound; prior.CABG = prior history of coronary artery bypass graft; prior.MI = prior history of myocardial infarction; RFYse = renal failure; SexMale = male; TL_LM = target lesion_left main coronary artery; TL_ProxLAD = target lesion proximal left anterior descending artery.**p<0.001.

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