Effect of institutional volume and academic status on outcomes of coronary interventions: The IMPACT-II experience

Ian Gilchrist, L. H. Gardner, J. B. Muhlestein, A. M. Arnold, A. M. Lincoff, R. M. Califf, J. E. Tcheng, E. J. Topol

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Rates of morbidity and mortality after interventional procedures are reported to be inversely associated with institutional volume. Methods: This study assessed both procedural volume and academic status at the 82 US centers that participated in the IMPACT-II trial. Interventional volumes at the sites ranged from 90 to 3300 cases per year. Patients were randomly assigned to a platelet glycoprotein IIb/IIIa inhibitor (eptifibatide) or placebo during procedures done by experienced operators. The primary end point was the composite of death, myocardial infarction, nonelective repeat coronary intervention, or nonelective coronary artery bypass surgery at 30 days, or placement of an intracoronary stent for abrupt closure during the initial procedure. Results: Baseline patient characteristics and median length of stay were similar between the academic and nonacademic centers. In univariable analysis, volume as a continuous variable had a nonlinear relation with the incidence of the composite end point, with better outcomes noted at the highest volume institutions. Academic status did not predict outcome. When added to a predictive model that contained the variables unstable angina, weight, prior coronary artery bypass grafting, heart rate, and platelet count, procedural volume continued to be associated with the composite outcome (P = .04). Conclusions: We conclude that among hospitals participating in this trial, there is a nonlinear relation between annual interventional volume and outcomes. This relation is complex, involving variations in periprocedural infarction rates and additional, undefined institutional differences (other than academic status) that result in differences in procedural outcome.

Original languageEnglish (US)
Pages (from-to)976-982
Number of pages7
JournalAmerican Heart Journal
Volume138
Issue number5 I
DOIs
StatePublished - Jan 1 1999

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Coronary Artery Bypass
Integrin beta3
Platelet Glycoprotein GPIIb-IIIa Complex
Unstable Angina
Platelet Count
Infarction
Stents
Length of Stay
Heart Rate
Myocardial Infarction
Placebos
Morbidity
Weights and Measures
Mortality
Incidence
eptifibatide

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Gilchrist, I., Gardner, L. H., Muhlestein, J. B., Arnold, A. M., Lincoff, A. M., Califf, R. M., ... Topol, E. J. (1999). Effect of institutional volume and academic status on outcomes of coronary interventions: The IMPACT-II experience. American Heart Journal, 138(5 I), 976-982. https://doi.org/10.1016/S0002-8703(99)70026-8
Gilchrist, Ian ; Gardner, L. H. ; Muhlestein, J. B. ; Arnold, A. M. ; Lincoff, A. M. ; Califf, R. M. ; Tcheng, J. E. ; Topol, E. J. / Effect of institutional volume and academic status on outcomes of coronary interventions : The IMPACT-II experience. In: American Heart Journal. 1999 ; Vol. 138, No. 5 I. pp. 976-982.
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Gilchrist, I, Gardner, LH, Muhlestein, JB, Arnold, AM, Lincoff, AM, Califf, RM, Tcheng, JE & Topol, EJ 1999, 'Effect of institutional volume and academic status on outcomes of coronary interventions: The IMPACT-II experience', American Heart Journal, vol. 138, no. 5 I, pp. 976-982. https://doi.org/10.1016/S0002-8703(99)70026-8

Effect of institutional volume and academic status on outcomes of coronary interventions : The IMPACT-II experience. / Gilchrist, Ian; Gardner, L. H.; Muhlestein, J. B.; Arnold, A. M.; Lincoff, A. M.; Califf, R. M.; Tcheng, J. E.; Topol, E. J.

In: American Heart Journal, Vol. 138, No. 5 I, 01.01.1999, p. 976-982.

Research output: Contribution to journalArticle

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T1 - Effect of institutional volume and academic status on outcomes of coronary interventions

T2 - The IMPACT-II experience

AU - Gilchrist, Ian

AU - Gardner, L. H.

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N2 - Background: Rates of morbidity and mortality after interventional procedures are reported to be inversely associated with institutional volume. Methods: This study assessed both procedural volume and academic status at the 82 US centers that participated in the IMPACT-II trial. Interventional volumes at the sites ranged from 90 to 3300 cases per year. Patients were randomly assigned to a platelet glycoprotein IIb/IIIa inhibitor (eptifibatide) or placebo during procedures done by experienced operators. The primary end point was the composite of death, myocardial infarction, nonelective repeat coronary intervention, or nonelective coronary artery bypass surgery at 30 days, or placement of an intracoronary stent for abrupt closure during the initial procedure. Results: Baseline patient characteristics and median length of stay were similar between the academic and nonacademic centers. In univariable analysis, volume as a continuous variable had a nonlinear relation with the incidence of the composite end point, with better outcomes noted at the highest volume institutions. Academic status did not predict outcome. When added to a predictive model that contained the variables unstable angina, weight, prior coronary artery bypass grafting, heart rate, and platelet count, procedural volume continued to be associated with the composite outcome (P = .04). Conclusions: We conclude that among hospitals participating in this trial, there is a nonlinear relation between annual interventional volume and outcomes. This relation is complex, involving variations in periprocedural infarction rates and additional, undefined institutional differences (other than academic status) that result in differences in procedural outcome.

AB - Background: Rates of morbidity and mortality after interventional procedures are reported to be inversely associated with institutional volume. Methods: This study assessed both procedural volume and academic status at the 82 US centers that participated in the IMPACT-II trial. Interventional volumes at the sites ranged from 90 to 3300 cases per year. Patients were randomly assigned to a platelet glycoprotein IIb/IIIa inhibitor (eptifibatide) or placebo during procedures done by experienced operators. The primary end point was the composite of death, myocardial infarction, nonelective repeat coronary intervention, or nonelective coronary artery bypass surgery at 30 days, or placement of an intracoronary stent for abrupt closure during the initial procedure. Results: Baseline patient characteristics and median length of stay were similar between the academic and nonacademic centers. In univariable analysis, volume as a continuous variable had a nonlinear relation with the incidence of the composite end point, with better outcomes noted at the highest volume institutions. Academic status did not predict outcome. When added to a predictive model that contained the variables unstable angina, weight, prior coronary artery bypass grafting, heart rate, and platelet count, procedural volume continued to be associated with the composite outcome (P = .04). Conclusions: We conclude that among hospitals participating in this trial, there is a nonlinear relation between annual interventional volume and outcomes. This relation is complex, involving variations in periprocedural infarction rates and additional, undefined institutional differences (other than academic status) that result in differences in procedural outcome.

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