ORLANDO-Better technique may have negated the angioplasty outcome advantage reported at hospitals doing high volumes.
A UCLA-Rand analysis of 1991 Medicare data has found no consistent link between the number of angioplasty procedures hospitals perform and their PTCA mortality rates. The study suggested that mortality data may be a more sensible quality gauge.
On the basis of pre-1990 data showing a small correlation between in-creased hospital angioplasty volume and lower PTCA mortality, the American Heart Association and American College of Cardiology recommended in 1993 that hospitals doing PTCA perform at least 200 procedures a year.
But the 1991 data on more than 113,000 Medicare angioplasties sug-gest that lower volumes no longer necessarily mean poorer outcomes,perhaps because of better experience and hardware, UCLA's Dr. Norman Kato told the ACC meeting here.
Of 856 angioplasty programs, those that did fewer than 50 procedures in 1991-one of the study's six arbitrary case-volume thresholds-showed a risk-adjusted procedural mortality of 2.79%, slightly but significantly higher than the 2.75% for centers that tallied more cases that year.
But the pattern reversed at all higher thresholds. For instance, centers at a 300-case threshold had a risk-adjusted mortality rate of 2.72%, vs. 2.85% for those with more.
But Dr. Thomas Ryan of Boston University, who chaired the group that set the AHA-ACC guidelines, says he isn't swayed. He cites Penn data from 1992-93, published in JAMA, suggestingthat even a 400-procedure minimum might not be out of line. -Steve Stiles
ORLANDO-Better technique may have negated the angioplasty outcome advantage reported at hospitals doing high volumes.
