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Hospital, Physician Volume Affect PCI Death Risk

Percutaneous coronary intervention patients have a lower risk in high-volume hospitals with high-volume physicians

WEDNESDAY, Feb. 11 (HealthDay News) -- Patients who undergo primary percutaneous coronary intervention (PCI) have a lower risk of death when the procedure is performed in high-volume hospitals with high-volume experienced physicians, researchers report in the Feb. 17 issue of the Journal of the American College of Cardiology.

Vankeepuram S. Srinivas, from Montefiore Medical Center, Bronx, N.Y., and colleagues examined the role of hospital and physician volume on in-hospital mortality after primary PCI using data from 7,321 patients undergoing the procedure for acute myocardial infarction.

The researchers report that the mortality risk was lower for high-volume hospitals (odds ratio, 0.58) and for high-volume physicians (OR, 0.66), with a significant relationship between hospital and physician volume and adjusted mortality. However, the risk-adjusted mortality rate in high-volume physicians in high-volume hospitals was lower but not significantly different from that of low-volume physicians in low-volume hospitals (3.8 versus 8.4 percent), the investigators found. In low-volume hospitals, the average risk-adjusted mortality rate was higher for low-volume physicians than high-volume physicians (OR, 1.44), while in high-volume hospitals, the average risk-adjusted mortality rate was lower for high-volume physicians than low-volume physicians (OR, 0.58), the report indicates.

"Although experience, selection bias and illness severity all contribute to the observed differences in mortality rates, these data continue to suggest that primary angioplasty is best performed on a regular basis by experienced cardiac teams," James G. Jollis, M.D., from Duke University Medical Center in Durham, N.C., writes in an accompanying editorial.

An author of the study and the editorial have financial relationships with the medical and pharmaceutical industries.

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