Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

The Association of Hospital Volume of Percutaneous Coronary Intervention with Cardiac Mortality

  • Kim, Jae-Hyun (Department of Health Administration, Dankook University College of Health Science) ;
  • Kim, Jang-Mook (Department of Health Administration, Dankook University College of Health Science) ;
  • Park, Eun-Cheol (Department of Preventive Medicine, Yonsei University College of Medicine)
  • Received : 2017.12.22
  • Accepted : 2018.03.12
  • Published : 2018.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: This study investigates the potential volume and outcome association of coronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) using a large and representative sample. Methods: We used a National Health Insurance Service-Cohort Sample Database from 2002 to 2013 released by the Korean National Health Insurance Service. A total of 8,908 subjects were analyzed. The primary analysis was based on Cox proportional hazards models to examine our hypothesis. Results: After adjusting for confounders, the hazard ratio of thirty-day and 1-year mortality in hospitals with a low volume of CHD patients with PCI was 2.8 and 2.2 times higher (p=0.00) compared to hospitals with a high volume of CHD patients with PCI, respectively. Thirty-day and 1-year mortality of CHD patients with PCI in low-volume hospitals admitted through the emergency room were 3.101 (p=0.00) and 2.8 times higher (p=0.01) than those in high-volume hospitals, respectively. Only 30-day mortality in low-volume hospitals of angina pectoris and myocardial infarction patients with PCI was 5.3 and 2.4 times those in high-volume hospitals with PCI, respectively. Conclusion: Mortality was significantly lower when PCI was performed in a high-volume hospital than in a low-volume hospital. Among patients admitted through the emergency room and diagnosed with angina pectoris, total PCI volume (low vs. high) was associated with significantly greater cardiac mortality risk of CHD patients. Thus, There is a need for better strategic approaches from both clinical and health policy standpoints for treatment of CHD patients.

Keywords

References

  1. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998;280(20):1747-1751. DOI: https://doi.org/10.1001/jama.280.20.1747.
  2. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346(15):1128-1137. DOI: https://doi.org/10.1056/NEJMsa012337.
  3. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized?: the empirical relation between surgical volume and mortality 1979. Clin Orthop Relat Res 2007;457:3-9. DOI: https://doi.org/10.1097/BLO.0b013e318034285e.
  4. McGrath PD, Wennberg DE, Dickens JD Jr, Siewers AE, Lucas FL, Malenka DJ, et al. Relation between operator and hospital volume and outcomes following percutaneous coronary interventions in the era of the coronary stent. JAMA 2000;284(24):3139-3144. DOI: https://doi.org/10.1001/jama.284.24.3139.
  5. Magid DJ, Calonge BN, Rumsfeld JS, Canto JG, Frederick PD, Every NR, et al. Relation between hospital primary angioplasty volume and mortality for patients with acute MI treated with primary angioplasty vs thrombolytic therapy. JAMA 2000;284(24):3131-3138. DOI: https://doi.org/10.1001/jama.284.24.3131.
  6. Jollis JG, Peterson ED, DeLong ER, Mark DB, Collins SR, Muhlbaier LH, et al. The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality. N Engl J Med 1994;331(24):1625-1629. DOI: https://doi.org/10.1056/NEJM199412153312406.
  7. Jollis JG, Peterson ED, Nelson CL, Stafford JA, DeLong ER, Muhlbaier LH, et al. Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients. Circulation 1997;95(11):2485-2491. DOI: https://doi.org/10.1161/01.cir.95.11.2485.
  8. Gruentzig AR, Myler RK, Hanna ES, Turina MI. Coronary transluminal angioplasty [abstract]. Circulation 1977;56(Suppl. 3):III-84.
  9. Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 1987;316(12):701-706. DOI: https://doi.org/10.1056/NEJM198703193161201.
  10. Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, et al. Randomized study with the Sirolimus-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo native coronary artery lesions: a randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002;346(23):1773-1780. DOI: https://doi.org/10.1056/NEJMoa012843.
  11. Grube E, Silber S, Hauptmann KE, Mueller R, Buellesfeld L, Gerckens U, et al. TAXUS I: six- and twelve-month results from a randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation 2003;107(1):38-42. DOI: https://doi.org/10.1161/01.cir.0000047700.58683.a1.
  12. Kedhi E, Joesoef KS, McFadden E, Wassing J, van Mieghem C, Goedhart D, et al. Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice (COMPARE): a randomised trial. Lancet 2010;375(9710):201-209. DOI: https://doi.org/10.1016/S0140-6736(09)62127-9.
  13. Serruys PW, Silber S, Garg S, van Geuns RJ, Richardt G, Buszman PE, et al. Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N Engl J Med 2010;363(2):136-146. DOI: https://doi.org/10.1056/NEJMoa1004130.
  14. Canto JG, Every NR, Magid DJ, Rogers WJ, Malmgren JA, Frederick PD, et al. The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators. N Engl J Med 2000;342(21):1573-1580. DOI: https://doi.org/10.1056/NEJM200005253422106.
  15. Phillips KA, Luft HS. The policy implications of using hospital and physician volumes as "indicators" of quality of care in a changing health care environment. Int J Qual Health Care 1997;9(5):341-348. DOI: https://doi.org/10.1093/intqhc/9.5.341.
  16. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/SCAI Writing Committee to update the 2001 guidelines for percutaneous coronary intervention). J Am Coll Cardiol 2006;47(1):216-235. DOI: https://doi.org/10.1016/j.jacc.2005.11.025.
  17. Smith SC Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines)-executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions. Circulation 2001;103(24):3019-3041. DOI: https://doi.org/10.1161/01.cir.103.24.3019.
  18. Milstein A, Galvin RS, Delbanco SF, Salber P, Buck CR Jr. Improving the safety of health care: the leapfrog initiative. Eff Clin Pract 2000;3(6):313-316.
  19. Tsuchihashi M, Tsutsui H, Tada H, Shihara M, Takeshita A, Kono S, et al. Volume-outcome relation for hospitals performing angioplasty for acute myocardial infarction: results from the Nationwide Japanese Registry. Circ J 2004;68(10):887-891. DOI: https://doi.org/10.1253/circj.68.887.
  20. Horiguchi H, Yasunaga H, Hashimoto H, Matsuda S. Impact of drug-eluting stents on treatment option mix for coronary artery disease in Japan. Circ J 2010;74(8):1635-1643. DOI: https://doi.org/10.1253/circj.cj-10-0061.
  21. Lee JY, Kim KH, Lee JS. Establishment of a nation cohort sample database using national health insurance data. Wonju: National Health Insurance Service; 2014.
  22. Spaulding C, Morice MC, Lancelin B, El Haddad S, Lepage E, Bataille S, et al. Is the volume-outcome relation still an issue in the era of PCI with systematic stenting? Results of the greater Paris area PCI registry. Eur Heart J 2006;27(9):1054-1060. DOI: https://doi.org/10.1093/eurheartj/ehi843.
  23. Hannan EL, Wu C, Walford G, King SB 3rd, Holmes DR Jr, Ambrose JA, et al. Volume-outcome relationships for percutaneous coronary interventions in the stent era. Circulation 2005;112(8):1171-1179. DOI: https://doi.org/10.1161/CIRCULATIONAHA.104.528455.
  24. Dawkins KD, Gershlick T, de Belder M, Chauhan A, Venn G, Schofield P, et al. Percutaneous coronary intervention: recommendations for good practice and training. Heart 2005;91 Suppl 6:vi1-27. DOI: https://doi.org/10.1136/hrt.2005.061457.
  25. Vakili BA, Kaplan R, Brown DL. Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in New York state. Circulation 2001;104(18):2171-2176. DOI: https://doi.org/10.1161/hc3901.096668.
  26. Kimmel SE, Sauer WH, Brensinger C, Hirshfeld J, Haber HL, Localio AR. Relationship between coronary angioplasty laboratory volume and outcomes after hospital discharge. Am Heart J 2002;143(5):833-840. DOI: https://doi.org/10.1067/mhj.2002.122116.
  27. Epstein AJ, Rathore SS, Volpp KG, Krumholz HM. Hospital percutaneous coronary intervention volume and patient mortality, 1998 to 2000: does the evidence support current procedure volume minimums? J Am Coll Cardiol 2004;43(10):1755-1762. DOI: https://doi.org/10.1016/j.jacc.2003.09.070.
  28. Smith SC Jr, Dove JT, Jacobs AK, Kennedy JW, Kereiakes D, Kern MJ, et al. ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)--executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). J Am Coll Cardiol 2001;37(8):2215-2239. DOI: https://doi.org/10.1016/s0735-1097(01)01344-4.
  29. Kimmel SE, Berlin JA, Strom BL, Laskey WK. Development and validation of simplified predictive index for major complications in contemporary percutaneous transluminal coronary angioplasty practice. The Registry Committee of the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 1995;26(4):931-938. DOI: https://doi.org/10.1016/0735-1097(95)00294-4.
  30. Moscucci M, Eagle KA, Share D, Smith D, De Franco AC, O'Donnell M, et al. Public reporting and case selection for percutaneous coronary interventions: an analysis from two large multicenter percutaneous coronary intervention databases. J Am Coll Cardiol 2005;45(11):1759-1765. DOI: https://doi.org/10.1016/j.jacc.2005.01.055.
  31. Zahn R, Gottwik M, Hochadel M, Senges J, Zeymer U, Vogt A, et al. Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients?: results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Heart 2008;94(3):329-335. DOI: https://doi.org/10.1136/hrt.2007.118737.
  32. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention--summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/SCAI Writing Committee to update the 2001 guidelines for percutaneous coronary intervention). Circulation 2006;113(1):156-175. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.170815.
  33. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation 2004;110(9):e82-e292.