TY - JOUR
T1 - Procedural volume and outcomes after percutaneous coronary intervention for unprotected left main coronary artery disease—report from the national clinical data (J-pci registry)
AU - Aikawa, Tadao
AU - Yamaji, Kyohei
AU - Nagai, Toshiyuki
AU - Kohsaka, Shun
AU - Kamiya, Kiwamu
AU - Omote, Kazunori
AU - Inohara, Taku
AU - Numasawa, Yohei
AU - Tsujita, Kenichi
AU - Amano, Tetsuya
AU - Ikari, Yuji
AU - Anzai, Toshihisa
N1 - Funding Information:
Dr Aikawa is supported by postdoctoral fellowships from the Uehara Memorial Foundation, the Kanzawa Medical Research Foundation, the Suginome Memorial Foundation, and the Nakayama Foundation for Human Science. Dr Aikawa was affiliated with a department with endowments from Medtronic Japan and Win International between April and August 2019. Dr Kohsaka reports investigator-initiated grant funding from Bayer and Daiichi Sankyo, and personal fees from Bayer and Bristol-Myers Squibb. Dr Kamiya was affiliated with a department with endowments from Medtronic Japan and Win International between September 2018 and March 2019. Dr Inohara has a research grant from Boston Scientific. Dr Amano receives lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi Sankyo, and Bristol-Myers Squibb. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2020, American Heart Association Inc.. All rights reserved.
PY - 2020/5/5
Y1 - 2020/5/5
N2 - BACKGROUND: There is a limited evidence base to support the volume-outcome relationship in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (UPLMD). This study aimed to evaluate the relationship between institutional and operator volume and in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. METHODS AND RESULTS: We analyzed characteristics and clinical outcomes of 24 320 patients undergoing PCI for unprotected left main coronary artery disease at 1102 hospitals by 7244 operators using data from the Japanese nationwide J-PCI Registry (National PCI Data Registry) between January 2014 and December 2017. We classified institutions and operators into quartiles based on the mean annual volume of PCI. A generalized linear mixed-effects model was used to evaluate the association between institutional and operator PCI volume and in-hospital outcomes. Among the 24 320 patients, 4027 (16.6%), 6147 (25.3%), and 14 146 (58.2%) presented with ST-segment–elevation myocardial infarction, non–ST-segment–elevation acute coronary syndrome, and stable ischemic heart disease; their crude in-hospital mortality was 15%, 3.1%, and 0.3%, respectively. Compared with patients in the lowest quartile of institutional volume (1–216 PCIs/y), the adjusted odds ratio of in-hospital death in patients in the second (217–323 PCIs/y), third (324–487 PCIs/y), and fourth (488–3015 PCIs/y) quartile of institutional volume was 0.75 (95% CI, 0.51–1.10; P=0.14), 0.87 (95% CI, 0.57–1.34; P=0.54), and 0.51 (95% CI, 0.30–0.86; P=0.01), respectively. These findings were consistent in rates of in-hospital death or any complication. Conversely, operator PCI volume was not significantly associated with in-hospital outcomes. CONCLUSIONS: Institutional rather than operator-based PCI volume was associated with better in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease.
AB - BACKGROUND: There is a limited evidence base to support the volume-outcome relationship in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery disease (UPLMD). This study aimed to evaluate the relationship between institutional and operator volume and in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease. METHODS AND RESULTS: We analyzed characteristics and clinical outcomes of 24 320 patients undergoing PCI for unprotected left main coronary artery disease at 1102 hospitals by 7244 operators using data from the Japanese nationwide J-PCI Registry (National PCI Data Registry) between January 2014 and December 2017. We classified institutions and operators into quartiles based on the mean annual volume of PCI. A generalized linear mixed-effects model was used to evaluate the association between institutional and operator PCI volume and in-hospital outcomes. Among the 24 320 patients, 4027 (16.6%), 6147 (25.3%), and 14 146 (58.2%) presented with ST-segment–elevation myocardial infarction, non–ST-segment–elevation acute coronary syndrome, and stable ischemic heart disease; their crude in-hospital mortality was 15%, 3.1%, and 0.3%, respectively. Compared with patients in the lowest quartile of institutional volume (1–216 PCIs/y), the adjusted odds ratio of in-hospital death in patients in the second (217–323 PCIs/y), third (324–487 PCIs/y), and fourth (488–3015 PCIs/y) quartile of institutional volume was 0.75 (95% CI, 0.51–1.10; P=0.14), 0.87 (95% CI, 0.57–1.34; P=0.54), and 0.51 (95% CI, 0.30–0.86; P=0.01), respectively. These findings were consistent in rates of in-hospital death or any complication. Conversely, operator PCI volume was not significantly associated with in-hospital outcomes. CONCLUSIONS: Institutional rather than operator-based PCI volume was associated with better in-hospital outcomes in patients undergoing PCI for unprotected left main coronary artery disease.
KW - Mortality/survival
KW - Percutaneous coronary intervention
KW - Revascularization
KW - Unprotected left main coronary artery disease
KW - Volume-outcome relationship
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U2 - 10.1161/JAHA.119.015404
DO - 10.1161/JAHA.119.015404
M3 - Article
C2 - 32347146
AN - SCOPUS:85084271294
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 9
M1 - e015404
ER -