Denktas, Ali E.

Introduction: There is paucity of data on the relationship between hospital procedural volume and outcomes of primary percutaneous coronary intervention (PCI) procedures in the past decade. Methods: We queried the National Inpatient Sample database (2010-2016) for hospitalizations undergoing primary PCI for STEMI. Hospitals were divided into 3 groups: low-volume (<36 primary PCI/ year), moderate-volume (36-72 primary PCI/year) and high-volume (>72 primary PCI/ year). The main outcome was in-hospital mortality. Results: The analysis included 694,505 hospitalizations for primary PCI. There were 329,878 (47.5%) primary PCI procedures performed at low-volume hospitals, 224,317 (32.3%) at moderate-volume, and 140,223 (20.2%) at high-volume hospitals. Compared with high-volume hospitals, low-volume hospitals were associated with higher in-hospital mortality in the unadjusted model (5.3% vs. 4.8%, odds ratio [OR] 1.10; 95% confidence interval-CI 1.02-1.18, p=0.01) and on multivariable analysis (adjusted-OR 1.15; 95%CI 1.04-1.27, p=0.01). There was no difference between moderate-volume and high-volume hospital in unadjusted analysis (5.1% vs. 4.8%, OR 1.07; 95%CI 0.99-1.15, p=0.11) and on multivariable analysis (adjusted-OR 1.08; 95%CI 0.97-1.20, p=0.17). Conclusions: This nationwide analysis showed that low-volume hospitals are associated with higher in-hospital mortality after primary PCI compared with high-volume hospitals even in recent years. The current threshold set by national guidelines for primary PCI hospitals remains valid in contemporary practice.

Background Electron-beam CT (EBCT) quantification of coronary artery calcification (CAC) allows noninvasive assessment of coronary atherosclerosis. We undertook a follow-up study to determine whether CAC extent, measured at the time of angiography by EBCT, predicted future hard cardiac events, comprising cardiac death and nonfatal myocardial infarction (MI). We also assessed the potential of selected coronary artery disease (CAD) risk factors, prior CAD event history (MI or revascularization), and angiographic findings (number of diseased vessels and overall disease burden) to predict subsequent hard events. Methods and Results Two hundred eighty-eight patients who underwent contemporaneous coronary angiography and EBCT scanning were contacted after a mean of 6.9 years. Vital status and history of MI during follow-up were determined. Cox proportional hazards models were used to compare the predictive ability of CAC extent with selected CAD risk factors, CAD event history, and angiographic findings. Median CAC score was 160 (range 0 to 7633). The 22 patients who experienced hard events during follow-up were older and had more extensive CAC and angiographic disease ( P <0.05). Only 1 of 87 patients with CAC score <20 experienced a subsequent hard event during follow-up. Event-free survival was significantly higher for patients with CAC scores <100 than for those with scores ≥100 (relative risk 3.20; 95% CI 1.17 to 8.71). When a stepwise multivariable model was used, only age and CAC extent predicted hard events (risk ratios 1.72 and 1.88, respectively; P <0.05). Conclusions In patients undergoing angiography, CAC extent on EBCT is highly predictive of future hard cardiac events and adds valuable prognostic information.