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November 21, 2002


American Heart Association Scientific Sessions Presentation: Emory Findings Dispute Previous Studies Linking High Volume of Percutaneous Coronary Interventions To Better Patient Outcomes

CHICAGO -- Past studies have concluded that patients undergoing percutaneous coronary interventions (PCIs) in hospitals performing a high volume of these procedures were less likely to die or to need urgent coronary bypass graft surgery (CABG). In 2001, in fact, the American College of Cardiology/ American Heart Association (ACC/AHA) Task Force increased the minimum annual volume requirement for hospitals performing percutaneous coronary interventions (PCIs) to 400 in response to studies demonstrating an inverse association between volume and outcomes.

However, a study presented today at the American Heart Association's Scientific Sessions by Emory cardiology fellow Sean C. Beinart, MD, disputes the conclusions of previous studies -- and raises the possibility hospital PCI volume may not be a good quality of care indicator.

"Our conclusions do not support the current AHA/ACC policy on minimum PCI volume recommendations," says Dr. Beinart, who analyzed the data for the Emory Center for Outcomes Research (ECOR) study. "In addition, we found that PCI procedural volume is not an independent predictor of mortality or urgent CABG."

The Emory research team (which included Emory cardiologist and ECOR Director William Weintraub and Elizabeth Mahoney, PhD, Assistant Professor of Medicine) studied data provided with permission and support of the American College of Cardiology, National Cardiovascular Data Registry (ACC-NCDR).

"The ACC-NCDR is the largest, most regionally diverse contemporary PCI registry with unique ability to examine the impact of facility volume on outcomes after adjusting for many demographic, clinical, and angiographic variables," says Dr. Beinart.

The Emory researchers evaluated the mortality rates for specific sites grouped by PCI volume and found that over half of the low volume sites had risk- adjusted mortality rates that were lower than the overall mortality in the ACC-NCDR.

What factors could explain why the new study's conclusions differ from those of previous studies? Dr. Beinart points out that there was a lack of regional diversity and/or the ability to adequately risk-adjust outcomes in earlier studies. In addition, most were done before the wide use of stents, tiny metal sheaths that help keep arteries open following PCI.

"Other facility based and process indicators of quality need to be identified also, such as nurse to patient ratios, " says Dr. Beinart. "And more adequate representation of low volume sites are needed to make definitive conclusions."

The study was supported in part by a grant from the American Heart Association.

The Emory Heart Center is comprised of all cardiology services and research at Emory University Hospital (EUH), Emory Crawford Long Hospital (ECLH) Carlyle Fraser Heart Center, the Andreas Gruentzig Cardiovascular Center of Emory University and the Emory Clinic. Ranked in the top ten of U.S. News & World Report's annual survey of the nation's best Heart Centers, the Emory Heart Center has a rich history of excellence in all areas of cardiology - including education, research and patient care. It is also internationally recognized as one of the birthplaces of modern interventional cardiology.

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