Volume-outcomes relationship in the era of modern coronary intervention-results from the prospective multicenter German DES.DE Registry.

OBJECTIVE: We compare clinical outcomes among unselected patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) stratified in categories of treating hospital PCI volume.

BACKGROUND: Previous observational evidence suggests an inverse relation between hospital volume and patients' outcomes. However, there are no mid-term outcomes data with the use of DES.

METHODS: We used data from DES.DE (German Drug-Eluting Stent) registry to compare in-hospital and 1-year outcomes among unselected patients. Primary endpoints at one year follow-up were the rate of major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR).

RESULTS: Between 2005 and 2006, 2,075 patients were treated in group I hospitals (<1,000 PCIs/year), 1,624 in group II hospitals (1,000-1,500 PCIs/year), and 1,790 in group III hospitals (>1,500 PCIs/year). Compared with group II and group III, group I allocation was associated with higher rates of overall hospital mortality (1.1% versus 0.2% versus 0.2%; P < 0.0001) and severe bleeding (1.0% versus 0.4% versus 0.5%; P < 0.05); similarly, poorer outcomes with respect to MACCE (7.2% versus 6.5% versus 4.7%; P < 0.01), stent thrombosis (5.2% versus 5.0% versus 3.0%; P < 0.01), and non-fatal stroke (1.5% versus 0.9% versus 0.7%; P < 0.05) were documented in group I. Conversely, TVR rates were highest in group II (10.2% versus 14.2% versus 11.7%; P < 0.01); these differences persisted after risk adjustment for heterogeneous baseline characteristics.

CONCLUSIONS: In the era of modern coronary intervention technological advances such as DES have not offset the inverse relation between procedural volume and both in-hospital and 1-year outcomes after PCI.