The association between institutional primary angioplasty procedure volumeand outcome in elderly Americans

Background The association between greater procedure volume and improved pa tient outcome in cardiac procedures has been established in percutaneous tr ansluminal coronary angioplasty; (PTCA), coronary stent placement and coron ary bypass surgery, The association between primary angioplasty volume and outcome has not been evaluated. Methods. We evaluated the association between the volume of primary angiopl asty procedures with short- and long-term outcome in 6,124 patients with do cumented acute myocardial infarction, Patients without shock on presentatio n treated with primary coronary angioplasty within 12 hours of hospital adm ission were selected from consecutive infarct patients included in the Coop erative Cardiovascular Project database. Patients were divided into quartil es based on the volume of primary PTCA procedures performed at their admitt ing hospital. Results. The majority of United States (US) hospitals performed less than t hree primary PTCA procedures per month. Patients admitted to hospitals in t he lowest volume quartile of primary PTCA had 31% higher 30-day mortality t han those admitted to the highest volume quartile, After adjustment for bas eline differences in patient characteristics, there was an association betw een admission to higher volume primary PTCA hospitals and lower 30-day mort ality (odds ratio per volume quartile = 0,91; 95% confidence interval = 0,8 3-0,99), Conclusion. Eighty-two percent of US hospitals perform less than three prim ary? PTCA procedures per month. In elderly Americans treated with primary P TCA, me observed an association between admission to higher volume hospital s and lower short- and long-term mortality. This association was independen t of total PTCA volumes.