A study in the November 25 issue of JAMA says that even though hospitals that perform a higher number of angioplasties are more likely to follow evidence-based guidelines and have shorter times to the angioplasty procedure, there appears to be no significant difference in outcomes such as length of hospital stay or risk of death.
Several studies have shown an inverse relationship between hospital primary angioplasty volume and the risk of death in patients with ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack). Based on the results of various studies, current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend that primary angioplasty in patients with STEMI be conducted by cardiac catheterization laboratories performing at least 36 primary angioplasties a year, as well as at least 200 total angioplasties a year, according to background information in the article.
"The majority of these studies were conducted before the regular use of stents and the routine use of newer adjunctive pharmacotherapy, such as dual antiplatelet therapy and glycoprotein IIb/IIIa inhibitors, both of which have been associated with better outcomes in these patients. However, more contemporary data supporting a relationship between hospital primary angioplasty volume and outcomes are not available," the authors write.
Dharam J. Kumbhani, M.D., S.M., of the Cleveland Clinic, and colleagues examined the relationship between hospital primary angioplasty volume and patient outcomes and quality of care measures for 29,513 patients presenting with STEMI at 166 angioplasty-capable hospitals across the United States. Patients received angioplasty between July 2001 and December 2007. Hospitals were divided into groups based on their annual primary angioplasty volume (less than 36 procedures per year, 36-70 procedures per year, and greater than 70 procedures per year).
