Open AccessHospital Volume and Cardiac Complications of Endomyocardial Biopsy: A Retrospective Cohort Study of 9508 Adult Patients Using a Nationwide Inpatient Database in Japan
Author(s) -
Isogai Toshiaki,
Yasunaga Hideo,
Matsui Hiroki,
Ueda Tetsuro,
Tanaka Hiroyuki,
Horiguchi Hiromasa,
Fushimi Kiyohide
Publication year - 2015
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22368
Subject(s) - medicine , pericardiocentesis , odds ratio , confidence interval , complication , surgery , retrospective cohort study , logistic regression , cardiac tamponade
ABSTRACT Background Recent research on complications with endomyocardial biopsy ( EMB ) has been based on single‐center or 2‐center studies in high‐volume cardiovascular centers. No study has examined the association between hospital volume and the complication rate after EMB . Hypothesis Hospital volume is inversely associated with cardiac complication rate after EMB . Methods Using the Diagnosis Procedure Combination database in Japan, we identified inpatients aged ≥20 years who underwent EMB under fluoroscopic guidance. We assessed cardiac complications requiring the following urgent procedures on the day of EMB or the day after: pericardiocentesis, surgical repair, and temporary pacing. Results Among 9508 eligible patients in 491 hospitals (male, 68%; mean age, 57.0 years), dilated cardiomyopathy was the most frequently diagnosed condition (35.4%). Twenty‐four patients (0.25%) required pericardiocentesis on the day of EMB . Three patients (0.03%) underwent surgical repair on the day of EMB or the day after. Sixty‐three patients (0.70%) required temporary pacing on the day of EMB . Higher hospital volume was associated with lower rates of pericardiocentesis (low volume, 0.4%; medium volume, 0.2%; high volume, 0.1%; P for the trend test, 0.019) and temporary pacing (low volume, 1.0%; medium volume, 0.7%; high volume, 0.2%; P for the trend test, < 0.001). In a multivariable logistic regression analysis, high hospital volume was significantly associated with a lower rate of the composite outcome of the procedures (reference, low volume; adjusted odds ratio, 0.22; 95% confidence interval, 0.08–0.62, P = 0.004). Conclusions Serious cardiac complications of EMB were rare, but higher hospital volume was associated with lower complication rate.