Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery †
Abstract
:1. Introduction
2. Methods
2.1. Data Sources
2.1.1. Japanese Cardiovascular Intervention and Therapeutics Registry: J-PCI
2.1.2. Japan Cardiovascular Surgical Database Adult Division: JCVSD Adult Division
2.1.3. Study Approval
2.2. Study Patients
2.3. Hospital Category
2.4. Study Outcomes
2.5. Statistical Analysis
3. Results
4. Outcomes
5. Discussion
6. Limitations
7. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
List of Abbreviations
ACCF | American College of Cardiology Foundation |
AHA | American Heart Association |
CABG | coronary artery bypass grafting |
JCVSD | Japan Cardiovascular Surgical Database |
J-PCI | PCI Registry for Japanese Association of Cardiovascular Intervention & Therapeutics |
PCI | percutaneous coronary intervention |
SCAI | Society for Cardiovascular Angiography and Interventions |
References
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CABG Volume Category | No CABG | 1–49 | 50 and above | p-Value |
---|---|---|---|---|
N (total = 220,934) | 56,580 | 110,459 | 53,895 | |
Age category | <0.001 | |||
20–39 | 391 (0.7%) | 1046 (1.0%) | 450 (0.8%) | |
40–59 | 9058 (16.0%) | 19,529 (17.7%) | 9498 (17.6%) | |
50–74 | 24,885 (44.0%) | 49,934 (45.2%) | 24,677 (45.8%) | |
75 and above | 22,246 (39.3%) | 39,950 (36.2%) | 19,270 (35.8%) | |
Diagnosis | <0.001 | |||
Stable Angina | 17,688 (31.3%) | 33,706 (30.5%) | 18,654 (34.6%) | |
Unstable Angina | 10,663 (18.9%) | 18,332 (16.6%) | 8648 (16.1%) | |
Acute Myocardial Infarction | 17,927 (31.7%) | 33,706 (30.5%) | 18,654 (34.6%) | |
Old Myocardial Infarction | 1572 (2.8%) | 3095 (2.8%) | 1494 (2.8%) | |
Silent Myocardial Ischemia | 8267 (14.6%) | 12,062 (10.9%) | 6030 (11.2%) | |
Other | 463 (0.8%) | 1070 (1.0%) | 430 (0.8%) | |
Emergent procedure | 21,140 (37.4%) | 49,042 (44.4%) | 21,981 (40.8%) | <0.001 |
Number of Vessels treated | <0.001 | |||
1 | 51,221 (90.5%) | 98,451 (89.1%) | 47,880 (88.8%) | |
2 | 3127 (5.5%) | 6398 (5.8%) | 3285 (6.1%) | |
3 or include LMT | 2232 (3.9%) | 510 (5.1%) | 2730 (5.1%) | |
Preprocedural condition | ||||
Cardiac Shock within 24 h of procedure | 2093 (3.7%) | 5347 (4.8%) | 1979 (3.7%) | <0.001 |
Acute heart failure | 3032 (5.4%) | 6419 (5.8%) | 2637 (4.9%) | <0.001 |
Cardiac Arrest within 24 h | 904 (1.6%) | 2933 (2.7%) | 1195 (2.2%) | <0.001 |
Comorbidities | ||||
Past Heart Failure | 4830 (8.5%) | 9647 (8.7%) | 4905 (9.1%) | <0.001 |
COPD | 969 (1.7%) | 1960 (1.8%) | 947 (1.8%) | 0.66 |
Hemodialysis | 2227 (3.9%) | 4715 (4.3%) | 2562 (4.8%) | <0.001 |
Renal dysfunction | 6633 (11.7%) | 15,322 (13.9%) | 7591 (14.1%) | <0.001 |
Diabetes | 21,395 (37.8%) | 41,911 (37.9%) | 20,167 (37.4%) | 0.12 |
AAA/PAD | 2946 (5.2%) | 5813 (5.3%) | 3258 (6.1%) | <0.001 |
Hypertension | 39,412 (69.7%) | 77,633 (70.3%) | 39,180 (72.7%) | <0.001 |
Number of facilities | 437 | 389 | 117 | |
Mean annual Case Volume | <0.001 | |||
1–99 | 197 (45.1%) | 35 (9.0%) | 3 (2.6%) | |
100–199 | 145 (33.2%) | 83 (21.3%) | 9 (7.7%) | |
200–399 | 87 (19.9%) | 194 (50.1%) | 53 (45.3%) | |
400 and above | 8 (1.8%) | 76 (19.5%) | 52 (44.4%) | |
Outcomes | ||||
Deaths | 535 (1.0%) | 1221 (1.1%) | 423 (0.8%) | <0.001 |
Composite Outcome | 1426 (2.5%) | 2831 (2.6%) | 1049 (2.0%) | <0.001 |
A. | ||||
Yearly CABG Volume | Yearly PCI Volume | |||
1–99 | 100–199 | 200–399 | 400 and above | |
None | ||||
Number of Facilities | 200 | 145 | 87 | 8 |
Number of Patients | 10,429 | 20,680 | 21,390 | 4081 |
In-Hospital Death | 144 (1.4%) | 231 (1.1%) | 157 (0.7%) | 3 (0.1%) |
In-Hospital Complications | 315 (3.0%) | 601 (2.9%) | 482 (2.3%) | 28 (0.7%) |
Number of Registered PCI Operators, median (min-max) | 2 (1–11) | 4 (1–13) | 6 (1–12) | 8.5 (1–14) |
Number of PCI per operator | 14 | 25 | 35 | 50.5 |
Predicted mortality, median (p5–p95) | 0.2% (0.04–2.7) | 0.2% (0.04–2.9) | 0.2% (0.04–2.6) | 0.1% (0.04–1.5) |
Ratio (PCI/CABG) median (p25–p75) | – | – | – | – |
1–49 | ||||
Number of Facilities | 36 | 83 | 195 | 76 |
Number of Patients | 2442 | 13,600 | 56,666 | 37,751 |
In-Hospital Death | 25 (1.0%) | 148 (1.1%) | 663 (1.2%) | 385 (1.0%) |
In-Hospital Complications | 85 (3.5%) | 338 (2.5%) | 1518 (2.7%) | 890 (2.4%) |
Number of Registered PCI Operators, median (min-max) | 3 (1–10) | 5 (1–24) | 8 (1–20) | 10 (4–23) |
Number of PCI per operator | 11 | 20 | 27 | 39 |
Predicted mortality, median (p5–p95) | 0.2% (0.04–4.3) | 0.3% (0.04–3.8) | 0.2% (0.04–4.3) | 0.2% (0.04–2.8) |
Ratio (PCI/CABG) median (p25–p75) | 5.2 (2.5–9.2) | 7.9 (5.0–11.6) | 11.4 (8.2–15.8) | 17.9 (12.8–26.7) |
50 and above | ||||
Number of Facilities | 3 | 9 | 53 | 52 |
Number of Patients | 194 | 1291 | 16,285 | 36,125 |
In-Hospital Death | 2 (1.0%) | 12 (0.9%) | 154 (1.0%) | 255 (0.7%) |
In-Hospital Complications | 4 (2.1%) | 47 (3.6%) | 382 (2.4%) | 616 (1.7%) |
Number of Registered PCI Operators, median (min-max) | 1 (1–5) | 6 (2–24) | 10 (4–28) | 15 (6–36) |
Number of PCI per operator | 40 | 10.5 | 19 | 32 |
Predicted mortality, median (p5–p95) | 0.3% (0.04–12.1) | 0.2% (0.04–4.0) | 0.2% (0.04–3.5) | 0.2% (0.04–2.4) |
Ratio (PCI/CABG) median (p25–p75) | 0.5 (0.01–1.7) | 2.0 (1.5–2.7) | 4.2 (2.9–5.1) | 7.5 (5.1–10.5) |
B. | ||||
Yearly CABG Volume | Yearly PCI Volume | |||
1–99 | 100–199 | 200–399 | 400 and above | |
None | ||||
OR for in-hospital death | 2.38 (1.56–3.63) | 1.82 (1.21–3.73) | 1.19 (0.76–1.85) | 0.28 (0.07–1.16) |
OR for in-hospital complications | 1.97 (1.44–2.70) | 1.83 (1.35–2.47) | 1.42 (1.02–1.96) | 0.71 (0.33–1.53) |
1–49 | ||||
OR for in-hospital death | 1.49 (0.76–2.90) | 1.41 (0.91–2.20) | 1.42 (0.98–2.05) | 1.22 (0.80–1.87) |
OR for in-hospital complications | 2.20 (1.39–3.48) | 1.26 (0.90–1.77) | 1.35 (1.02–1.79) | 1.18 (0.85–1.63) |
50 and above | ||||
OR for in-hospital death | 0.79 (0.08–7.86) | 1.08 (0.39–2.99) | 1.06 (0.66–1.71) | reference group |
OR for in-hospital complications | 1.23 (0.25–5.91) | 2.17 (1.08–4.36) | 1.19 (0.83–1.70) | reference group |
(A) With inclusion of ACS patients only. | ||||
Yearly CABG Volume | Yearly PCI Volume | |||
1–99 | 100–199 | 200–399 | 400 and above | |
None | ||||
OR for in-hospital death | 2.45 (1.58–3.78) | 1.82 (1.20–2.76) | 1.28 (0.81–2.03) | 0.34 (0.08–1.46) |
OR for in-hospital complications | 2.09 (1.47–2.97) | 2.00 (1.43–2.80) | 1.65 (1.14–2.37) | 0.85 (0.36–2.03) |
1–49 | ||||
OR for in-hospital death | 1.56 (0.79–3.07) | 1.39 (0.88–2.2) | 1.42 (0.97–2.08) | 1.18 (0.76–1.82) |
OR for in-hospital complications | 2.33 (1.40–3.87) | 1.31 (0.90–1.90) | 1.45 (1.06–1.99) | 1.21 (0.85–1.74) |
50 or above | ||||
OR for in-hospital death | 0.80 (0.08–8.20) | 0.99 (0.34–2.89) | 1.01 (0.62–1.66) | reference group |
OR for in-hospital complications | 1.68 (0.31–8.95) | 2.04 (0.93–4.45) | 1.20 (0.81–1.79) | reference group |
(B) With exclusion of institutions with extremely low number of PCI (<50/yr) or CABG (<15/yr) volume. | ||||
Yearly CABG Volume | Yearly PCI Volume | |||
50–99 | 100–199 | 200–399 | 400 and above | |
None | ||||
OR for in-hospital death | 2.43 (1.54–3.84) | 1.82 (1.21–2.74) | 1.19 (0.76–1.86) | 0.28 (0.07–1.17) |
OR for in-hospital complications | 2.13 (1.53–2.96) | 1.83 (1.36–2.47) | 1.42 (1.03–1.95) | 0.71 (0.33–1.51) |
15–49 | ||||
OR for in-hospital death | 0.88 (0.31–2.56) | 1.29 (0.79–2.10) | 1.39 (0.95–2.05) | 1.29 (0.83–2.00) |
OR for in-hospital complications | 1.33 (0.66–2.68) | 1.23 (0.86–1.77) | 1.29 (0.97–1.71) | 1.22 (0.88–1.70) |
50 or above | ||||
OR for in-hospital death | 1.03 (0.08–12.95) | 1.08 (0.39–3.00) | 1.06 (0.66–1.71) | reference group |
OR for in-hospital complications | 0.44 (0.05–3.88) | 2.17 (1.09–4.31) | 1.19 (0.84–1.70) | reference group |
Yearly CABG Volume | Yearly PCI Volume | |||
---|---|---|---|---|
Max 210 | Max 313.5 | Max 478.5 | Above 478.5 | |
None | ||||
OR for in-hospital death | 2.02 (1.34–3.05) | 1.12 (0.67–1.87) | 0.91 (0.37–2.21) | 0.13 (0.01–1.35) |
OR for in-hospital complications | 1.82 (1.34–2.47) | 1.39 (0.96–2.02) | 0.86 (0.46–1.63) | 0.71 (0.27–1.84) |
Max 26.5 | ||||
OR for in-hospital death | 1.73 (1.08–2.78) | 1.50 (0.92–2.43) | 1.15 (0.68–1.94) | 0.98 (0.46–2.07) |
OR for in-hospital complications | 1.62 (1.14–2.31) | 1.26 (0.88–1.82) | 1.09 (0.73–1.61) | 0.7 (0.39–1.24) |
Max 49 | ||||
OR for in-hospital death | 1.05 (0.58–1.90) | 1.32 (0.8–2.18) | 1.23 (0.75–2.03) | 1.56 (0.86–2.85) |
OR for in-hospital complications | 1.23 (0.80–1.91) | 1.28 (0.88–1.88) | 1.13 (0.77–1.65) | 1.68 (1.06–2.65) |
50 and above | ||||
OR for in-hospital death | 1.20 (0.52–2.77) | 1.05 (0.58–1.91) | 1.09 (0.62–1.90) | reference group |
OR for in-hospital complications | 2.01 (1.12–3.62) | 1.16 (0.75–1.81) | 1.01 (0.66–1.55) | reference group |
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Kohsaka, S.; Kumamaru, H.; Inohara, T.; Amano, T.; Akasaka, T.; Miyata, H.; Motomura, N.; Nakamura, M. Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery. J. Clin. Med. 2020, 9, 1267. https://doi.org/10.3390/jcm9051267
Kohsaka S, Kumamaru H, Inohara T, Amano T, Akasaka T, Miyata H, Motomura N, Nakamura M. Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery. Journal of Clinical Medicine. 2020; 9(5):1267. https://doi.org/10.3390/jcm9051267
Chicago/Turabian StyleKohsaka, Shun, Hiraku Kumamaru, Taku Inohara, Tetsuya Amano, Takashi Akasaka, Hiroaki Miyata, Noboru Motomura, and Masato Nakamura. 2020. "Outcome of Percutaneous Coronary Intervention in Relation to the Institutional Volume of Coronary Artery Bypass Surgery" Journal of Clinical Medicine 9, no. 5: 1267. https://doi.org/10.3390/jcm9051267