Quality of PCI procedures consistent across US hospitals, regardless of ranking

Devraj Sukul

ANAHEIM, Calif. — The outcomes after percutaneous coronary intervention procedures performed at hospitals across the United States were not significantly different at centers ranked among the best in the nation for cardiology compared with those that are unranked, according to research presented at the American Heart Association Scientific Sessions.

“We did this study because prior research has generally demonstrated that top-ranked (i.e. ‘Best Hospitals’) hospitals did better than unranked hospitals for many cardiovascular conditions,” Devraj Sukul, MD, cardiology fellow at the University of Michigan in Ann Arbor, told Cardiology Today.

“However, due to significant quality-improvement initiatives aimed at improving PCI outcomes, along with advances in pharmacologic therapies and technical aspects of PCI care over the past 25 years, there may be many hospitals around the United States performing safe and high-quality PCI. Therefore, we wanted to see if top-ranked hospitals performed better than unranked hospitals for this commonly performed cardiovascular procedure,” he said.

Similar outcomes, appropriate procedures

The researchers evaluated data from hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from 2014 to 2015. Those included in the 2015 U.S. News & World Report’s 50 Best Hospitals for Cardiology and Heart Surgery were considered top-ranked for this study. Of 509,153 PCI procedures performed at 654 hospitals during the study period, 55,550 (10.9%) were performed at 44 top-ranked hospitals. Hospitals, including top-ranked hospitals, were excluded if they did not submit data to the CathPCI Registry or if they performed under 400 annual PCI procedures.

Top-ranked hospitals, compared with unranked hospitals, had similar odds of in-hospital mortality (adjusted OR = 0.96; 95% CI, 0.83-1.12), acute kidney injury (adjusted OR = 1.1; 95% CI, 0.98-1.22) and bleeding (adjusted OR = 1.15; 95% CI, 0.999-1.31), according to the data.

In addition, the proportion of appropriate PCI was lower at top-ranked compared with unranked hospitals (89.2% vs. 92.8%; OR = 0.56; 95% CI, 0.45-0.69); however, the overall proportion of inappropriate PCI was low ranging between 1% and 3%.

Sukul and colleagues also assessed a subset of elective non-ACS PCIs, including 79,682 procedures performed at 653 hospitals. Of these, 13,416 (16.8%) were performed top-ranked hospitals. Again, results indicated no significant differences between top-ranked and unranked hospitals in odds of mortality (adjusted OR = 1.37; 95% CI, 0.81-2.33), acute kidney injury (adjusted OR = 1.17; 95% CI, 0.96-1.44) or bleeding (adjusted OR = 1.27; 95% CI, 0.99-1.63). In this subset, the proportion of inappropriate PCI was lower at unranked compared with top-ranked hospitals (10.9% vs. 12.1%). However, after accounting for hospital volume, the odds of performing appropriate PCI (OR = 0.98; 95% CI, 0.84-1.19) or inappropriate PCI (OR = 1.16; 95% CI, 0.93-1.44) were similar at top-ranked and unranked hospitals.

Results were generally consistent in a sensitivity analysis that included hospitals that performed less than 400 PCI procedures annually.

The researchers noted several limitations of this study. The authors focused only on PCI appropriateness and outcomes which is a narrow, albeit important, aspect of cardiovascular care. Also, the research did not include all hospitals performing PCIs in the United Statesas participation in the CathPCI registry is voluntary. This may limit the generalizability of the findings.

Reassuring data

These findings are encouraging, according to Sukul.

“We found no significant differences in the risk for in-hospital outcomes, including death, bleeding and kidney injury after PCI at top-ranked and non-ranked hospitals,” he said. “In general, our findings should reassure patients that safe and appropriate PCI is being performed across the nation in hospitals participating in the NCDR CathPCI registry and meeting minimum volume requirements.”

In an editorial accompanying the study’s simultaneous publication in JACC: Cardiovascular Interventions, Gregory J. Dehmer, MD, MACC, MSCAI, vice president and medical director of cardiovascular services at Baylor Scott & White Medical Center in Temple, Texas, noted that factors such as insurance appear to be more influential than public reporting or website ratings for patients looking for a health care provider.

“Despite the external forces that determine where an individual is directed for health care and the plethora of rating sites and results, this study addresses what is often the foremost question of a patient and their family in their hometown — Is my local hospital doing a good job? To the extent measured by the variables in this study, it is reassuring that the answer appears to be ‘yes,’” Dehmer wrote.

“As hospital-profiling initiatives continue to grow, I believe that hospitals, clinical registries and national professional organizations should continue to assist in reporting efforts aimed at improving transparency, accountability and ultimately, health care quality,” Sukul told Cardiology Today. – by Melissa Foster

References:

Sukul D, et al. Abstract S2003. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, California.

Sukul D, et al. JACC Cardiovasc Interv. 2017;doi:10.1016/j.jcin.2017.10.042.

Dehmer GJ. JACC Cardiovasc Interv. 2017;doi:10.1016/j.jcin.2017.11.001.

Disclosures: Sukul and Dehmer report no relevant financial disclosures.