Impact of hospital proportion and volume on primary percutaneous coronary intervention performance in England and Wales

To quantify the determinants of primary percutaneous coronary intervention (PCI) performance in England and Wales between 2004 and 2007. All 8653 primary PCI cases admitted to acute hospitals in England and Wales as recorded in the Myocardial Ischaemia National Audit Project (MINAP) 2004-2007. We st...

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Bibliographic Details
Published in:	European heart journal Vol. 32; no. 6; pp. 706 - 711
Main Authors:	WEST, Robert M, CATTLE, Brian A, GALE, Chris P, BOUYSSIE, Marianne, SQUIRE, Lain, DE BELDER, Mark, FOX, Keith A. A, BOYLE, Roger, MCLENACHAN, Jim M, BATIN, Philip D, GREENWOOD, Darren C
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-03-2011
Subjects:	Aged Angioplasty, Balloon, Coronary - standards Angioplasty, Balloon, Coronary - statistics & numerical data Biological and medical sciences Cardiology. Vascular system Coronary heart disease Diseases of the cardiovascular system Emergency Medical Services - standards Emergency Medical Services - statistics & numerical data England - epidemiology Female Health Facility Size - statistics & numerical data Heart Hospital Mortality Humans Male Medical Audit Medical sciences Middle Aged Myocardial Infarction - mortality Myocardial Infarction - therapy Myocardial Revascularization - statistics & numerical data Myocarditis. Cardiomyopathies Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Thrombolytic Therapy - statistics & numerical data Time Factors Wales - epidemiology England United Kingdom Great Britain Europe Wales Performance evaluation Myocardial infarction Prognosis Angioplasty Hospital volume Cardiovascular disease Time Myocardial disease Stent Percutaneous route Proportion Primary STEMI Hospital Cardiology Door-to-balloon time Atherectomy Primary PCI Mortality Coronary artery Instrumentation therapy Coronary heart disease Volume Hospital proportion Sounding balloon Circulatory system Performance
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Summary:	To quantify the determinants of primary percutaneous coronary intervention (PCI) performance in England and Wales between 2004 and 2007. All 8653 primary PCI cases admitted to acute hospitals in England and Wales as recorded in the Myocardial Ischaemia National Audit Project (MINAP) 2004-2007. We studied the impact of the volume of primary PCI cases (hospital volume) on door-to-balloon (DTB) times and the proportion of patients treated with primary PCI (hospital proportion) on 30-day mortality and employed regression analysis to identify reasons for DTB time variations with a multilevel component to express hospital variation. The proportion of patients receiving primary PCI increased from 5% in 2004 to 20% in 2007. Median DTB times reduced from 84 min in 2004 to 61 min in 2007. Median DTB times decreased as the number of primary PCI procedures increased. The 30-day all-cause mortality rate for hospitals performing primary PCI on >25% of ST-elevation myocardial infarction patients [5.0%; 95% confidence interval (CI): 3.9-6.1%] was almost double that of hospitals performing primary PCI on more than 75% (2.7%; 95% CI: 2.0-3.5%). Time-of-day, year of admission, sex, and diabetes significantly influenced DTB times. Hospital variation was evident by a hospital-level DTB time standard deviation of 12 min. There was a large variation in DTB times between the best and worst performing hospitals. Although patient-related factors impacted upon DTB times, the volume and proportion of patients undergoing primary PCI were significantly associated with delay and early mortality-hospitals with the highest proportion of primary PCI had the lowest mortality.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0195-668X 1522-9645
DOI:	10.1093/eurheartj/ehq476