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

Jun Shiraishi; Yoshio Kohno; Takahisa Sawada; Masayasu Arihara; Masayuki Hyogo; Takakazu Yagi; Takatomo Shima; Takashi Okada; Takeshi Nakamura; Satoaki Matoba; Hiroyuki Yamada; Takeshi Shirayama; Tetsuya Tatsumi; Makoto Kitamura; Keizo Furukawa; Hiroaki Matsubara; The AMI-Kyoto Multi-Center Risk Study Group

doi:10.1253/circj.72.1041

Clinical Investigation

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

Jun Shiraishi, Yoshio Kohno, Takahisa Sawada, Masayasu Arihara, Masayuki Hyogo, Takakazu Yagi, Takatomo Shima, Takashi Okada, Takeshi Nakamura, Satoaki Matoba, Hiroyuki Yamada, Takeshi Shirayama, Tetsuya Tatsumi, Makoto Kitamura, Keizo Furukawa, Hiroaki Matsubara, The AMI-Kyoto Multi-Center Risk Study Group

Author information

Jun Shiraishi
Department of Cardiology, Kyoto First Red Cross Hospital
Yoshio Kohno
Department of Cardiology, Kyoto First Red Cross Hospital
Takahisa Sawada
Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine
Masayasu Arihara
Department of Emergency Medicine, Kyoto First Red Cross Hospital
Masayuki Hyogo
Department of Cardiology, Kyoto First Red Cross Hospital
Takakazu Yagi
Department of Cardiology, Kyoto First Red Cross Hospital
Takatomo Shima
Department of Cardiology, Kyoto First Red Cross Hospital
Takashi Okada
Department of Cardiology, Kyoto First Red Cross Hospital
Takeshi Nakamura
Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine
Satoaki Matoba
Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine
Hiroyuki Yamada
Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine
Takeshi Shirayama
Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine
Tetsuya Tatsumi
Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine
Makoto Kitamura
Department of Cardiology, Kyoto Second Red Cross Hospital
Keizo Furukawa
Department of Cardiology, Kyoto City Hospital
Hiroaki Matsubara
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

Keywords: Mortality, Myocardial infarction, Primary percutaneous coronary intervention

JOURNAL FREE ACCESS

2008 Volume 72 Issue 7 Pages 1041-1046

DOI https://doi.org/10.1253/circj.72.1041

Details

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)

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