Coronary intervention patients fare better in high-volume centers
MedWire News: Patients undergoing coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) in a high-volume hospital have lower in-hospital mortality than those treated at low-volume hospitals, finds a meta-analysis.
The study, published online in the European Heart Journal, found significant 13% and 15% reductions in odds of in-hospital mortality among PCI and CABG patients treated at high-volume centers, respectively.
Piet Post (Dutch Institute for Healthcare Improvement, The Netherlands) and colleagues identified 15 studies reporting the effect of yearly volume of coronary interventions on in-hospital mortality, two of which reported data on both CABG and PCI.
The studies all included hospital volume as an independent variable and a cut-off to distinguish between high and low volume.
Meta-analysis of 10 studies on PCI including a total of 1,322,342 patients revealed an overall odds ratio for in-hospital mortality of 0.87 for patients treated in a high-volume versus low-volume hospital.
Of note, studies containing a higher proportion of patients treated with stents reported a stronger relationship between volume and outcome, and more recent studies appeared to show a smaller effect size than earlier studies.
Similarly, meta-analysis of the seven CABG studies including a total of 1,470,990 patients also revealed a significant effect of high volume, with an odds ratio for in-hospital mortality of 0.85 for higher versus lower volume centers.
There was no evidence of attenuation of this effect in more recent compared with earlier studies.
Although most of the included studies originated in the USA, the researchers say that it is likely a similar relationship exists in other countries.
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By Caroline Price