Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Relationship between Percutaneous Transluminal Coronary Anigioplasty Volume and Associated Immediate Outcome

경피적 관동맥 확장술의 시술량과 조기 시술결과의 관련성

  • Kim, Yong-Ik (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Kim, Chang-Yup (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Lee, Young-Sung (Department of Health Policy and Management, Chungbuk National University College of Medicine) ;
  • Kim, Sun-Mean (Korea Health Industry Development Institute) ;
  • Lee, Jin-Seok (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Oh, Byung-Hee (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Khang, Young-Ho (Department of Preventive Medicine, University of Ulsan College of Medicine)
  • 김용익 (서울대학교 의과대학 의료관리학교실) ;
  • 김창엽 (서울대학교 의과대학 의료관리학교실) ;
  • 이영성 (충북대학교 의과대학 의료관리학교실) ;
  • 김선민 (한국보건산업진흥원) ;
  • 이진석 (서울대학교 의과대학 의료관리학교실) ;
  • 오병희 (서울대학교 의과대학 내과학교실) ;
  • 강영호 (울산대학교 의과대학 예방의학교실)
  • Published : 2001.03.01
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Abstract

Objectives : To explore the relationship between Percutaneous Transluminal Coronary Angioplasty(PTCA) volume and the associated immediate outcome. Methods : A total of 1,379 PTCAs were peformed in 25 hospitals in Korea between October 8 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. Results : Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals ($\geq200$ cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. Conclusions : After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.

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