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

Publication ,  Journal Article
Gilchrist, IC; Gardner, LH; Muhlestein, JB; Arnold, AM; Lincoff, AM; Califf, RM; Tcheng, JE; Topol, EJ
Published in: Am Heart J
November 1999

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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Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

November 1999

Volume

138

Issue

5 Pt 1

Start / End Page

976 / 982

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Retrospective Studies
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Peptides
  • Outcome Assessment, Health Care
  • Multi-Institutional Systems
  • Middle Aged
  • Male
 

Citation

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Gilchrist, I. C., 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. Am Heart J, 138(5 Pt 1), 976–982. https://doi.org/10.1016/s0002-8703(99)70026-8
Gilchrist, I. C., L. H. Gardner, J. B. Muhlestein, A. M. Arnold, A. M. Lincoff, R. M. Califf, J. E. Tcheng, and E. J. Topol. “Effect of institutional volume and academic status on outcomes of coronary interventions: the IMPACT-II experience.Am Heart J 138, no. 5 Pt 1 (November 1999): 976–82. https://doi.org/10.1016/s0002-8703(99)70026-8.
Gilchrist IC, Gardner LH, Muhlestein JB, Arnold AM, Lincoff AM, Califf RM, et al. Effect of institutional volume and academic status on outcomes of coronary interventions: the IMPACT-II experience. Am Heart J. 1999 Nov;138(5 Pt 1):976–82.
Gilchrist, I. C., et al. “Effect of institutional volume and academic status on outcomes of coronary interventions: the IMPACT-II experience.Am Heart J, vol. 138, no. 5 Pt 1, Nov. 1999, pp. 976–82. Pubmed, doi:10.1016/s0002-8703(99)70026-8.
Gilchrist IC, Gardner LH, Muhlestein JB, Arnold AM, Lincoff AM, Califf RM, Tcheng JE, Topol EJ. Effect of institutional volume and academic status on outcomes of coronary interventions: the IMPACT-II experience. Am Heart J. 1999 Nov;138(5 Pt 1):976–982.
Journal cover image

Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

November 1999

Volume

138

Issue

5 Pt 1

Start / End Page

976 / 982

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Retrospective Studies
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Peptides
  • Outcome Assessment, Health Care
  • Multi-Institutional Systems
  • Middle Aged
  • Male