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Volume–outcomes relationship in the Era of modern coronary intervention—results from the prospective multicenter German DES.DE Registry
Author(s) -
Akin Ibrahim,
Hochadel Mathias,
Schneider Steffen,
AbdelWahab Mohamed,
Zahn Ralf,
Senges Jochen,
Richardt Gert,
Kuck KarlHeinz,
Nienaber Christoph A.
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24986
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , stent , cardiology , stroke (engine) , observational study , revascularization , clinical endpoint , drug eluting stent , myocardial infarction , randomized controlled trial , mechanical engineering , engineering
Objective We compare clinical outcomes among unselected patients undergoing percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) stratified in categories of treating hospital PCI volume. Background Previous observational evidence suggests an inverse relation between hospital volume and patients' outcomes. However, there are no mid‐term outcomes data with the use of DES. Methods We used data from DES.DE (German Drug‐Eluting Stent) registry to compare in‐hospital and 1‐year outcomes among unselected patients. Primary endpoints at one year follow‐up were the rate of major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR). Results Between 2005 and 2006, 2,075 patients were treated in group I hospitals (<1,000 PCIs/year), 1,624 in group II hospitals (1,000–1,500 PCIs/year), and 1,790 in group III hospitals (>1,500 PCIs/year). Compared with group II and group III, group I allocation was associated with higher rates of overall hospital mortality (1.1% versus 0.2% versus 0.2%; P < 0.0001) and severe bleeding (1.0% versus 0.4% versus 0.5%; P < 0.05); similarly, poorer outcomes with respect to MACCE (7.2% versus 6.5% versus 4.7%; P < 0.01), stent thrombosis (5.2% versus 5.0% versus 3.0%; P < 0.01), and non‐fatal stroke (1.5% versus 0.9% versus 0.7%; P < 0.05) were documented in group I. Conversely, TVR rates were highest in group II (10.2% versus 14.2% versus 11.7%; P < 0.01); these differences persisted after risk adjustment for heterogeneous baseline characteristics. Conclusions In the era of modern coronary intervention technological advances such as DES have not offset the inverse relation between procedural volume and both in‐hospital and 1‐year outcomes after PCI. © 2013 Wiley Periodicals, Inc.