Inpharma 1270 - 13 Jan 2001 Survival after acute MI may depend on hospital volume Survival of patients with acute myocardial infarction (MI) appears to be higher among those who receive primary angioplasty, compared with those who receive thrombolytic therapy, in high-volume hospitals, say researchers from the US. 1 * However, they add that mortality outcomes are similar in patients treated with primary angioplasty or thrombolysis at low-volume hospitals. In this retrospective study, survival rates were analysed using data from the US National Registry of Myocardial Infarction for a cohort of 62 299 patients with acute MI who received primary angioplasty (n = 21 973) or thrombolytic therapy at 446 acute care hospitals (111, 223 and 112 were classified as high-, intermediate- and low-volume, respectively). ** Lower mortality Unadjusted in-hospital mortality was significantly lower among patients treated with primary angioplasty, compared with those treated with thrombolysis, at intermediate-volume hospitals (4.5 vs 5.9%) and at high- volume hospitals (3.4 vs 5.4%). However, at low-volume hospitals, unadjusted in-hospital mortality was not significantly different between patients treated with primary angioplasty and those treated with thrombolysis (6.2 vs 5.9%). Quality of care most important factor In an accompanying editorial, Dr James Jollis from Duke University Medical Center, Durham, North Carolina, US, and Dr Patrick Romano from the University of California, Davis, Sacramento, US, say that the above-mentioned study data ‘suggest that percutaneous coronary interventions including primary angioplasty generally should not be conducted in low- volume hospitals unless there are substantial overriding concerns about geographic or socioeconomic access’. 2 However, they conclude that ‘ultimately, what matters even more than hospital or physician volume is ensuring highest-quality care and optimal outcomes for patients with myocardial infarction’. * Hospitals were classified into primary angioplasty volume groups based on the annual number of procedures performed: high-, intermediate- and low-volume groups were defined as ≥ 49, 17–48 and ≤ 16 procedures per year, respectively. ** The study was supported in part by Genentech Inc. 1. Magid DJ, et al. Relation between hospital primary angioplasty volume and mortality for patients with acute MI treated with primary angioplasty vs thrombolytic therapy. JAMA: the Journal of the American Medical Association 284: 3131-3138, 27 Dec 2000. 2. Jollis JG, et al. Volume-outcome relationship in acute myocardial infarction. JAMA: the Journal of the American Medical Association 284: 3169-3171, 27 Dec 2000. 800840310 1 Inpharma 13 Jan 2001 No. 1270 1173-8324/10/1270-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Survival after acute MI may depend on hospital volume

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Inpharma 1270 - 13 Jan 2001

Survival after acute MI may dependon hospital volume

Survival of patients with acute myocardial infarction(MI) appears to be higher among those who receiveprimary angioplasty, compared with those who receivethrombolytic therapy, in high-volume hospitals, sayresearchers from the US.1* However, they add thatmortality outcomes are similar in patients treated withprimary angioplasty or thrombolysis at low-volumehospitals.

In this retrospective study, survival rates wereanalysed using data from the US National Registry ofMyocardial Infarction for a cohort of 62 299 patientswith acute MI who received primary angioplasty (n = 21973) or thrombolytic therapy at 446 acute care hospitals(111, 223 and 112 were classified as high-,intermediate- and low-volume, respectively).**

Lower mortalityUnadjusted in-hospital mortality was significantly

lower among patients treated with primary angioplasty,compared with those treated with thrombolysis, atintermediate-volume hospitals (4.5 vs 5.9%) and at high-volume hospitals (3.4 vs 5.4%). However, at low-volumehospitals, unadjusted in-hospital mortality was notsignificantly different between patients treated withprimary angioplasty and those treated with thrombolysis(6.2 vs 5.9%).

Quality of care most important factorIn an accompanying editorial, Dr James Jollis from

Duke University Medical Center, Durham, NorthCarolina, US, and Dr Patrick Romano from theUniversity of California, Davis, Sacramento, US, say thatthe above-mentioned study data ‘suggest thatpercutaneous coronary interventions including primaryangioplasty generally should not be conducted in low-volume hospitals unless there are substantial overridingconcerns about geographic or socioeconomic access’.2

However, they conclude that ‘ultimately, what matterseven more than hospital or physician volume is ensuringhighest-quality care and optimal outcomes for patientswith myocardial infarction’.* Hospitals were classified into primary angioplasty volume groupsbased on the annual number of procedures performed: high-,intermediate- and low-volume groups were defined as ≥ 49, 17–48and ≤ 16 procedures per year, respectively.** The study was supported in part by Genentech Inc.

1. Magid DJ, et al. Relation between hospital primary angioplasty volume andmortality for patients with acute MI treated with primary angioplasty vsthrombolytic therapy. JAMA: the Journal of the American Medical Association284: 3131-3138, 27 Dec 2000.

2. Jollis JG, et al. Volume-outcome relationship in acute myocardial infarction.JAMA: the Journal of the American Medical Association 284: 3169-3171, 27Dec 2000.

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