Hospital PCI volume advice overly cautious

Main Category: Public Health
Article Date: 31 May 2004 - 8:00 PDT

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US recommendations on the number of procedures that hospitals offering percutaneous coronary intervention (PCI) should perform each year may err on the side of caution, study findings suggest.

Current guidelines from the American College of Cardiology and the American Heart Association advise that hospitals offering PCI perform at least 400 interventions each year.

This volume threshold is based primarily on PCI studies performed in the late 1980s and early 1990s that identified an increased risk of death for PCI patients treated at hospitals with annual volumes of less than 400 cases per year.

Andrew Epstein (University of Pennsylvania, Philadelphia) and colleagues note, however, that these studies were conducted before the adoption and widespread use of stents and drug therapies such as glycoprotein IIb/IIIa inhibitors, and predate an increase in the overall use of PCI.

The researchers therefore examined whether the standard still predicted better survival by analyzing federal administrative billing records on 362,748 patients who underwent PCI between 1998 and 2000.

They found that, in comparison with high-volume hospitals (400+ PCIs/year), death rates were higher at low-volume hospitals (<200 procedures/year, odds ratio=1.21), but similar at medium-volume institutions (200-399 PCIs/year), after adjusting for patient characteristics.

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