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Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry)
BACKGROUND: There is a limited evidence base to support the volume‐outcome relationship in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (UPLMD). This study aimed to evaluate the relationship between institutional and operator volume a...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428587/ https://www.ncbi.nlm.nih.gov/pubmed/32347146 http://dx.doi.org/10.1161/JAHA.119.015404 |
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author | Aikawa, Tadao Yamaji, Kyohei Nagai, Toshiyuki Kohsaka, Shun Kamiya, Kiwamu Omote, Kazunori Inohara, Taku Numasawa, Yohei Tsujita, Kenichi Amano, Tetsuya Ikari, Yuji Anzai, Toshihisa |
author_facet | Aikawa, Tadao Yamaji, Kyohei Nagai, Toshiyuki Kohsaka, Shun Kamiya, Kiwamu Omote, Kazunori Inohara, Taku Numasawa, Yohei Tsujita, Kenichi Amano, Tetsuya Ikari, Yuji Anzai, Toshihisa |
author_sort | Aikawa, Tadao |
collection | PubMed |
description | BACKGROUND: There is a limited evidence base to support the volume‐outcome relationship in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (UPLMD). This study aimed to evaluate the relationship between institutional and operator volume and in‐hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. METHODS AND RESULTS: We analyzed characteristics and clinical outcomes of 24 320 patients undergoing PCI for unprotected left main coronary artery disease at 1102 hospitals by 7244 operators using data from the Japanese nationwide J‐PCI Registry (National PCI Data Registry) between January 2014 and December 2017. We classified institutions and operators into quartiles based on the mean annual volume of PCI. A generalized linear mixed‐effects model was used to evaluate the association between institutional and operator PCI volume and in‐hospital outcomes. Among the 24 320 patients, 4027 (16.6%), 6147 (25.3%), and 14 146 (58.2%) presented with ST‐segment–elevation myocardial infarction, non–ST‐segment–elevation acute coronary syndrome, and stable ischemic heart disease; their crude in‐hospital mortality was 15%, 3.1%, and 0.3%, respectively. Compared with patients in the lowest quartile of institutional volume (1–216 PCIs/y), the adjusted odds ratio of in‐hospital death in patients in the second (217–323 PCIs/y), third (324–487 PCIs/y), and fourth (488–3015 PCIs/y) quartile of institutional volume was 0.75 (95% CI, 0.51–1.10; P=0.14), 0.87 (95% CI, 0.57–1.34; P=0.54), and 0.51 (95% CI, 0.30–0.86; P=0.01), respectively. These findings were consistent in rates of in‐hospital death or any complication. Conversely, operator PCI volume was not significantly associated with in‐hospital outcomes. CONCLUSIONS: Institutional rather than operator‐based PCI volume was associated with better in‐hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. |
format | Online Article Text |
id | pubmed-7428587 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74285872020-08-17 Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry) Aikawa, Tadao Yamaji, Kyohei Nagai, Toshiyuki Kohsaka, Shun Kamiya, Kiwamu Omote, Kazunori Inohara, Taku Numasawa, Yohei Tsujita, Kenichi Amano, Tetsuya Ikari, Yuji Anzai, Toshihisa J Am Heart Assoc Original Research BACKGROUND: There is a limited evidence base to support the volume‐outcome relationship in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (UPLMD). This study aimed to evaluate the relationship between institutional and operator volume and in‐hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. METHODS AND RESULTS: We analyzed characteristics and clinical outcomes of 24 320 patients undergoing PCI for unprotected left main coronary artery disease at 1102 hospitals by 7244 operators using data from the Japanese nationwide J‐PCI Registry (National PCI Data Registry) between January 2014 and December 2017. We classified institutions and operators into quartiles based on the mean annual volume of PCI. A generalized linear mixed‐effects model was used to evaluate the association between institutional and operator PCI volume and in‐hospital outcomes. Among the 24 320 patients, 4027 (16.6%), 6147 (25.3%), and 14 146 (58.2%) presented with ST‐segment–elevation myocardial infarction, non–ST‐segment–elevation acute coronary syndrome, and stable ischemic heart disease; their crude in‐hospital mortality was 15%, 3.1%, and 0.3%, respectively. Compared with patients in the lowest quartile of institutional volume (1–216 PCIs/y), the adjusted odds ratio of in‐hospital death in patients in the second (217–323 PCIs/y), third (324–487 PCIs/y), and fourth (488–3015 PCIs/y) quartile of institutional volume was 0.75 (95% CI, 0.51–1.10; P=0.14), 0.87 (95% CI, 0.57–1.34; P=0.54), and 0.51 (95% CI, 0.30–0.86; P=0.01), respectively. These findings were consistent in rates of in‐hospital death or any complication. Conversely, operator PCI volume was not significantly associated with in‐hospital outcomes. CONCLUSIONS: Institutional rather than operator‐based PCI volume was associated with better in‐hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. John Wiley and Sons Inc. 2020-04-29 /pmc/articles/PMC7428587/ /pubmed/32347146 http://dx.doi.org/10.1161/JAHA.119.015404 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Aikawa, Tadao Yamaji, Kyohei Nagai, Toshiyuki Kohsaka, Shun Kamiya, Kiwamu Omote, Kazunori Inohara, Taku Numasawa, Yohei Tsujita, Kenichi Amano, Tetsuya Ikari, Yuji Anzai, Toshihisa Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry) |
title | Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry) |
title_full | Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry) |
title_fullStr | Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry) |
title_full_unstemmed | Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry) |
title_short | Procedural Volume and Outcomes After Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease—Report From the National Clinical Data (J‐PCI Registry) |
title_sort | procedural volume and outcomes after percutaneous coronary intervention for unprotected left main coronary artery disease—report from the national clinical data (j‐pci registry) |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428587/ https://www.ncbi.nlm.nih.gov/pubmed/32347146 http://dx.doi.org/10.1161/JAHA.119.015404 |
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