Objective: The purpose of this study is to determine whether hospital procedure volume is associated with complications of percutaneous coronary interventions (PCI) using the American College of Cardiology - National Cardiovascular Data Registry (ACC-NCDR). The null hypothesis is that the frequency of risk-adjusted adverse outcomes will be independent of annual PCI hospital volume. Background: Several studies have concluded that an inverse relationship exists between hospital PCI volume and adverse outcomes causing a recent increase in the recommended minimum procedure requirements for PCI-performing institutions by the ACC/AHA Task Force. These studies, however, were limited by data that lacked substantial clinical variables, represented a confined geographic region, or were not reflective of current PCI practice. The ACC-NCDR resolves these concerns and could provide more insight into this important clinical question with broad health policy implications. Methods: The population, were consecutive PCI patients (n~169,000) from over 350 hospitals nationwide. Outcome variables will be in-hospital mortality, Q-wave MI, lab complications, and emergent CABG. The main independent variable will be facility procedure volume. Risk adjustment models will be fit using logistic regression. Candidate variables in each of the models will include a very comprehensive set of demographic, clinical, and angiographic characteristics. A plot showing final adjusted effect of procedural volume and mortality will be generated. Estimated risk-adjusted mortality for each site will be determined.
