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Higher Volume of Angioplasty May Not Improve Outcomes

Better door-to-balloon times but in-hospital mortality rates are the same

TUESDAY, Nov. 24 (HealthDay News) -- The number of angioplasty procedures a hospital performs affects the median door-to-balloon time, and use of evidence-based treatments, but in-hospital mortality rates do not improve with higher volumes, according to a study published in the Nov. 25 issue of the Journal of the American Medical Association.

Dharam J. Kumbhani, M.D., of the Cleveland Clinic, and colleagues analyzed data from 166 hospitals in the United States on 29,513 patients who underwent angioplasty to treat ST-segment elevation myocardial infarction, dividing the facilities according to the number of procedures they performed -- less than 36, 36 to 70, and more than 70 a year.

The best door-to-balloon times were achieved by high-volume centers, at 88 minutes versus 90 minutes for medium-volume, and 98 minutes for low-volume centers, the researchers found. All three groups had similar lengths of stay, but high-volume centers were more likely to follow evidence-based guidelines at discharge. However, the investigators note, angioplasty volume had no impact on in-hospital mortality rates, which were similar for all three groups.

"Our results, especially with respect to in-hospital mortality, are contrary to other published registry studies," the authors write. "One of the main differences is that our study reflects more contemporary practice. Angioplasty techniques and adjunctive pharmacotherapy have seen substantial improvements over the past few years, and there has been a significant standardization of these practices nationwide."

The Get With the Guidelines program is supported by Merck-Schering Plough Pharmaceutical. Several authors reported relationships with the pharmaceutical industry.

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