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CLINICAL STUDIES

Frequency of major adverse cardiac events within one month of coronary angioplasty: a useful measure of operator performance

^a Section of Cardiology, the Washington Hospital Center, Washington, DC, USA

Manuscript received February 9, 1999; revised manuscript received June 14, 1999, accepted August 25, 1999.

Reprint requests and correspondence: Dr. Joseph Lindsay, Jr, Section of Cardiology, Washington Hospital Center, 110 Irving St. Northwest, Washington, DC 20010
JML2{at}MHG.edu

OBJECTIVES

To test one-month outcomes in a single center for their statistical power to corroborate conclusions derived from large multicenter databases.

BACKGROUND

Only with large, multicenter databases has it been possible to demonstrate more frequent occurrences of complications in patients treated by "low-volume operators." Critics feel that such analyses mask excellent performance by many "low-volume operators."

METHODS

In a high-volume cardiac catheterization laboratory in a large, nonuniversity teaching hospital, baseline clinical and angiographic characteristics were collected for a consecutive series of 1,029 patients treated by 37 percutaneous transluminal coronary intervention (PTCI) operators over a four-month period. One-month follow-up was obtained in 967 (94%) patients who form the basis for this analysis.

RESULTS

Only the group of operators performing <50 cases annually had a major adverse cardiac event (MACE) (death, myocardial infarction or symptom-driven revascularization) rate at one month significantly greater than predicted from baseline characteristics. (Observed rate: 15.1%, expected: 9.7%, 95% confidence interval [CI]: 4.7%, 14.6%.) The difference was driven by the significantly more frequent rate at which repeat revascularization was performed in patients treated by that group of operators (observed: 13.8%, expected: 7.1%, 95% CI: 2.8%, 11.4%).

CONCLUSIONS

As is true of analyses of large multicenter databases, lower volume operators as a group have less good outcomes than those performing more. The greater statistical power provided by one-month MACE rate offers advantages over the use of in-hospital complications for the analysis of operator performance.

Abbreviations and Acronyms   CABG = coronary artery bypass surgery   MACE = major adverse cardiac event (death, myocardial infarction, symptom-driven revascularization)   PTCI = percutaneous transluminal coronary intervention

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