European Heart Journal Advance Access published online on March 28, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi843
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1 Cardiology Department, Cochin Hospital, Rene Descartes University, 27 rue du Fg St Jacques, 75014 Paris, France
* To whom correspondence should be addressed. Aims In acute myocardial infarction (AMI), primary percutaneous transluminal angioplasty (PTCA) is the preferred option when it can be performed rapidly. Because of the limited access to high PTCA volume centres in some areas, it has been suggested that PTCA could be performed in low-volume centres on AMI patients. Little data exist on the validity of this strategy in modern era PTCA. Methods and results The Greater Paris area comprises 11 million inhabitants and accounts for 18% of the French population. In 2001, the hospital agency of the Greater Paris area set up a registry of all PTCAs performed in this region. Data from 2001 and 2002 was analysed. Hospitals performing <400 PTCAs per year were classified as low-volume. A case-control analysis (propensity score) compared in-hospital mortality in low- and high-volume centres. A total of 37 848 angioplasty procedures were performed in 44 centres during the study period; 24.7% were performed in low-volume centres. A non-statistically significant trend towards reduced in-hospital mortality was noted in high-volume centres as opposed to low-volume centres: 2.01 vs. 2.42%, P=0.057. In-hospital mortality rates were significantly different in the sub-group of emergency procedures: 6.75% in high- vs. 8.54% in low-volume centres, P=0.028. No difference was noted between low- and high-volume centres in non-emergency procedures (0.62 vs. 0.62%, P=0.99). Conclusion In the era of modern stenting, a clear inverse relationship exists between hospital PTCA volume and in-hospital mortality after emergency procedures. Tolerance of low-volume thresholds for angioplasty centres with the purpose of providing primary PTCA in AMI should not be recommended, even in underserved areas.
Received March 28, 2005
Revised February 23, 2006
Accepted March 9, 2006
Clinical review
Is the volume-outcome relation still an issue in the era of PCI with systematic stenting? Results of the greater Paris area PCI registry
Christian Spaulding 1 *,
Marie-Claude Morice 2,
Bernard Lancelin 3,
Simon El Haddad 4,
Eric Lepage 5,
Sophie Bataille 6,
Jean-Pierre Tresca 6,
Xavier Mouranche 6,
Sandrine Fosse 6,
Mehran Monchi 2,
Nikita de Vernejoul 6,
and
for the CARDIO-ARIF registry Investigators
2 Institut Cardiovasculaire Paris-Sud, Massy, France
3 Cardiology Department, Marie Lannelongue Hospital, Le Plessis Robinson, France
4 Cardiology Department, Lagny-Marne la Vallee Hospital, Lagny, France
5 Department of Medical Information, Henri Mondor Hospital, Creteil, France
6 Agence Régionale d'Hospitalisation d'Ile de France, Paris, France
Christian Spaulding, E-mail: christian.spaulding{at}cch.ap-hop-paris.fr
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