WESTPORT, CT (Reuters Health) – Patients with acute myocardial infarction who undergo primary angioplasty performed by high-volume physicians or at high-volume hospitals have significantly lower in-hospital mortality than similar patients undergoing the same procedure by low-volume providers.
Dr. David L. Brown from Montefiore Medical Center, Bronx, New York, and colleagues used the New York State Coronary Angioplasty Reporting System Registry to collect data on 1342 patients who underwent angioplasty within 23 hours of an acute MI in 32 New York State hospitals.
None of these patients had thrombolytic therapy before angioplasty, according to the report in the October 30th issue of Circulation: Journal of the American Heart Association.
When the angioplasty was performed by high-volume physicians, in-hospital mortality was 57% lower (ie, adjusted relative risk 0.43) than when the procedure was performed by low-volume physicians, the researchers found. In-hospital mortality was reduced by 44% (adjusted relative risk 0.56) when the angioplasty was performed in a high-volume hospital compared with a low volume hospital.
When the procedure was performed at a high-volume hospital by high-volume physicians, in-hospital mortality was 49% lower (adjusted relative risk 0.51) compared with performance by low-volume physicians in low-volume hospitals, Dr. Brown's team notes.
The data also revealed that patients treated at low-volume hospitals whether by low-volume or high-volume physicians have the same mortality if treated with primary angioplasty or thrombolytic therapy.
"It is the combination of experienced physicians in high-volume hospitals with established protocols that appears to make the greatest difference," Dr. Brown says in a journal statement. "If individual physicians who have more experience in the PTCA (percutaneous transluminal coronary angioplasty) procedure operate in low-volume hospitals, the outcomes are not as good," he adds.
"Whether volume standards should be applied to hospitals or operators performing primary angioplasty is a difficult and controversial issue," Dr. Mark A. Hlatky from Stanford University School of Medicine, California and Dr. R. Adams Dudley from the University of California, San Francisco, comment in a journal editorial.
"Volume of procedures should be measured and reviewed, but this is only one component of a complete set of performance measures for acute myocardial infarction," they say.
Circulation 2001;104:2155-2157,2171-2176.
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