The volume-outcome relationship of percutaneous coronary intervention: can current procedure volume minimums be applied to a developing country?

Am Heart J. 2008 Mar;155(3):547-52. doi: 10.1016/j.ahj.2007.10.029. Epub 2008 Jan 15.


Objectives: A minimum percutaneous coronary intervention (PCI) hospital volume of 400 cases per year is recommended by the American College of Cardiology/American Heart Association (ACC/AHA). However, it is unclear whether this minimum value standard applies to non-Western developing countries, such as Taiwan. The aim of this study was to assess the application in Taiwan of current ACC/AHA practice guidelines for minimum hospital PCI volume.

Methods: Using the 2003 Taiwan National Health Insurance Research Database and the Cause of Death Data File, we analyzed and compared the risk of 30-day mortality for patients (n = 12369) treated at low- (< 200 cases per year), medium- (200-399 cases per year), and high- (> or = 400 cases per year) PCI volume hospitals. A multivariable logistic regression using generalized estimating equations was conducted to assess the independent association of hospital PCI volume and patient 30-day mortality.

Results: Crude 30-day mortality rates among low-, medium-, and high-PCI volume hospitals were 3.10%, 2.82%, and 1.80%, respectively. Patients treated at low-PCI volume hospitals had 1.54 (95% CI, 1.17-2.02) times higher odds of 30-day mortality than those treated at high-PCI volume hospitals after adjusting for other factors. The adjusted odds ratio between medium- and high-volume hospitals did not reach statistical significance (odds ratio 1.33, 95% CI 0.91-1.56).

Conclusions: Though greater, the adjusted odds of 30-day mortality for patients undergoing PCI at medium-volume hospitals was not significantly different from those of patients treated at high-volume hospitals. This suggests that current ACC/AHA PCI hospital volume minimums may need to be reevaluated in non-Western countries such as Taiwan.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / mortality
  • Angioplasty, Balloon, Coronary / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Hospitals / statistics & numerical data*
  • Humans
  • Male
  • Myocardial Ischemia / mortality
  • Myocardial Ischemia / therapy*
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Quality of Health Care
  • Retrospective Studies
  • Survival Rate / trends
  • Taiwan / epidemiology
  • Treatment Outcome