Effects of Hospital Volume of Primary Percutaneous Coronary Interventions on Angiographic Results and In-Hospital Outcomes for Acute Myocardial Infarction

• Shiraishi Jun

  Department of Cardiology, Kyoto First Red Cross Hospital

• Kohno Yoshio

  Department of Cardiology, Kyoto First Red Cross Hospital

• Sawada Takahisa

  Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine

• Arihara Masayasu

  Department of Emergency Medicine, Kyoto First Red Cross Hospital

• Hyogo Masayuki

  Department of Cardiology, Kyoto First Red Cross Hospital

• Yagi Takakazu

  Department of Cardiology, Kyoto First Red Cross Hospital

• Shima Takatomo

  Department of Cardiology, Kyoto First Red Cross Hospital

• Okada Takashi

  Department of Cardiology, Kyoto First Red Cross Hospital

• Nakamura Takeshi

  Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine

• Matoba Satoaki

  Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine

• Yamada Hiroyuki

  Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine

• Shirayama Takeshi

  Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine

• Tatsumi Tetsuya

  Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine

• Kitamura Makoto

  Department of Cardiology, Kyoto Second Red Cross Hospital

• Furukawa Keizo

  Department of Cardiology, Kyoto City Hospital

• Matsubara Hiroaki

  Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine

• The AMI-Kyoto Multi-Center Risk Study Group

  Members of the AMI-Kyoto Multi-Center Risk Study Group are listed in Appendix 1

Abstract

Background Several clinical studies have demonstrated an inverse relationship between hospital volume of primary percutaneous coronary interventions (PCI) and in-hospital mortality. However, the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis in patients with acute myocardial infarction (AMI) have not been fully investigated in Japan. Methods and Results Using the AMI-Kyoto Multi-Center Risk Study database between January 2000 and December 2005, hospitals were classified into quintiles based on their annual volume of primary PCI. The fifth quintile of hospitals was labeled as high-volume, and the other quintiles were combined and defined as low-volume. Although patients undergoing primary PCI in high-volume hospitals (high-volume group, n=764) had a larger number of diseased vessels at initial coronary angiography and lower Thrombolysis In Myocardial Infarction (TIMI) flow grade in the infarct-related artery before PCI, compared with those in low-volume hospitals (low-volume group, n=1,021), the rates of achieving TIMI flow grade 3 just after PCI in the high-volume group was significantly higher than that in the low-volume group. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class ≥3 at admission, multivessel disease or left main trunk (LMT) as culprit lesion, number of diseased vessels ≥2 or diseased LMT, and age were the independent positive predictors of in-hospital mortality, whereas the TIMI flow grade 3 after primary PCI and elapsed time <24 h were the negative ones, but not low-volume hospital. Conclusions Angiographic results of primary PCI in high-volume hospitals were superior to those in low-volume hospitals, but there was no significant difference in the in-hospital mortality between AMI patients in high-volume hospitals and those in low-volume hospitals. (Circ J 2008; 72: 1041 - 1046)<br>

Journal

• Circulation Journal

  Circulation Journal 72 (7), 1041-1046, 2008

  The Japanese Circulation Society

Keywords

• Mortality
• Myocardial infarction
• Primary percutaneous coronary intervention

Details

• CRID: 1390001205101968256
• NII Article ID: 110006792053
• NII Book ID: AA11591968
• DOI: 10.1253/circj.72.1041
• ISSN: 13474820
• ISSN: 13469843
• Web Site: http://www.jstage.jst.go.jp/article/circj/72/7/72_7_1041/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2008361986
• Text Lang: en
• Data Source:
  • JaLC
  • Crossref
  • CiNii Articles
• Abstract License Flag: Disallowed