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Volume-outcome relationship in complication-related mortality after percutaneous coronary interventions: an analysis on the failure-to-rescue rate in the Japanese Nationwide Registry

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Abstract

In-hospital mortality following percutaneous coronary intervention (PCI) varies across institutions with different annual PCI volumes. The failure to rescue (FTR) rate, defined as the mortality rate following PCI-related complications, may account for the volume-outcome relationship. The Japanese Nationwide PCI Registry, a consecutive, nationally mandated registry between 2019 and 2020, was queried. The FTR rate is defined as ‘the number of patients who died following PCI-related complications’ divided by ‘the number of patients who experienced at least one PCI-related complication.’ Multivariate analysis was used to calculate the risk-adjusted odds ratio (aOR) of the FTR rates among hospitals stratified into tertiles as low (≤ 236/year), medium (237–405/year), and high (≥ 406/year). A total of 465,716 PCIs and 1007 institutions were included. A volume-outcome relationship was observed for in-hospital mortality, and the medium-volume (aOR 0.90, 95% confidence interval [CI] 0.85–0.96), as well as high-volume (aOR 0.84, 95% CI 0.79–0.89) hospitals, had significantly lower in-hospital mortality than low-volume hospitals. Complication rates were lower at high-volume centers (1.9%, 2.2%, and 2.6% for high-, medium-, and low-volume centers, respectively; p < 0.001). The overall FTR rate was 19.0%. The FTR rates for the low-, medium-, and high-volume hospitals were 19.3%, 17.7%, and 20.6%, respectively. The medium-volume hospitals had a lower FTR rate (aOR 0.82, 95% [CI] 0.68–0.99), whereas the FTR rate was similar at the high-volume hospitals compared with that of the low-volume hospitals (aOR 1.02, 95% CI 0.83–1.26). In-hospital mortality was low after PCI in high-volume hospitals. However, the FTR rate in high-volume hospitals was not necessarily lower than that in low-volume hospitals. The FTR rate did not account for the volume-outcome relationship in PCI.

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Authors and Affiliations

  1. Center of Cardiovascular Disease, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai Ward, Kawasaki, Kanagawa, 212-0014, Japan

    Tomo Ando, Motoki Fukutomi, Takayuki Onishi & Tetsuya Tobaru

  2. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Kyohei Yamaji

  3. Department of Cardiovascular Medicine, Keio University Graduate School of Medicine, Tokyo, Japan

    Shun Kohsaka & Taku Inohara

  4. Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan

    Hideki Ishii

  5. Department of Cardiovascular Medicine, Aichi Medical University Graduate School of Medicine, Aichi, Japan

    Tetsuya Amano

  6. Department of Cardiology, Tokai University Graduate School of Medicine, Isehara, Japan

    Yuji Ikari

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  1. Tomo Ando
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  2. Kyohei Yamaji
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  3. Shun Kohsaka
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  4. Motoki Fukutomi
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  5. Takayuki Onishi
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  6. Taku Inohara
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  7. Hideki Ishii
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  8. Tetsuya Amano
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  10. Tetsuya Tobaru
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Corresponding author

Correspondence to Tomo Ando.

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Conflict of interest

K.Y. reports investigator-initiated grant funding from Abbott. H.I. received lecture fees from Astellas Pharma, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Mochida Pharma, Novartis Pharma, and Otsuka Pharma. T.A. receives lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi Sankyo, and Bristol-Myers Squibb. The rest of the authors have no conflict of interest to report. S.K. has received an unrestricted research grant from the Department of Cardiology, Keio University School of Medicine, Bayer Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., and Novartis Pharmaceutical Co., Ltd. All other authors have no related disclosures.

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Ando, T., Yamaji, K., Kohsaka, S. et al. Volume-outcome relationship in complication-related mortality after percutaneous coronary interventions: an analysis on the failure-to-rescue rate in the Japanese Nationwide Registry. Cardiovasc Interv and Ther 38, 388–394 (2023). https://doi.org/10.1007/s12928-023-00935-w

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  • DOI: https://doi.org/10.1007/s12928-023-00935-w

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