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Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice

An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database

Mauro Moscucci, MD^_*,_*, David Share, MD, MPH^_*, Dean Smith, PhD, Michael J. O'Donnell, MD, Arthur Riba, MD, Richard McNamara, MD^||, Thomas Lalonde, MD^¶, Anthony C. Defranco, MD^#, Kirit Patel, MD^**, Eva Kline Rogers, RN, MS^_*, Chris D'Haem, DO, Milind Karve, MD and Kim A. Eagle, MD^_*

^_* Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
St. Joseph Mercy Hospital, Ann Arbor, Michigan
Blue Cross Blue Shield of Michigan, Detroit, Michigan, USA
^¶ St. John's Hospital and Medical Center, Detroit, Michigan
Oakwood Hospital, Dearborn, Michigan
^|| Spectrum Health, Grand Rapids, Michigan
^# McLaren Regional Medical Center, Flint, Michigan
^** St. Joseph Hospital, Pontiac, Michigan
Ingham Regional Medical Center, Lansing, MichiganUSA
Sparrow Medical Center, Lansing, Michigan

View larger version (22K): [in a new window]   Figure 1 Adjusted odds ratios (OR) for major adverse cardiovascular events with generalized estimating equations clustering modeling. Variables included in the final model were: quintiles one to four, age, gender, history of congestive heart failure, history of prior coronary artery bypass grafting, history of extra-cardiac vascular disease, history of chronic obstructive pulmonary disease, emergency procedure, creatinine 1.5 mg/dl, left ventricular ejection fraction <50%, American College of Cardiology type C lesion, left main stenosis (>70%), three-vessel disease (>70%), visible thrombus on the initial coronary angiogram, cardiac arrest, acute myocardial infarction (MI), MI within 7 days, cardiogenic shock, ventricular tachycardia or ventricular fibrillation in the setting of acute MI, and unstable angina. C statistic = 0.82. Hosmer-Lemeshow chi-square = 2.9, p = 0.94. CI = confidence interval.

View larger version (41K): [in a new window]   Figure 2 Relationship between operator volume and patients' risk. Predicted and observed major adverse cardiovascular events (MACE) rates are stratified by quartile of risk, with further stratification by quintile of operator volume. Q = quintile (i.e., Q1, Q2, Q3, Q4, and Q5).

View larger version (16K): [in a new window]   Figure 3 Linear plot of standardized major adverse cardiovascular events (MACE) ratios (observed/predicted rates) versus annual operator volume.