Optimal catchment area and primary PCI centre volume revisited: a single-centre experience in transition from high-volume centre to "mega centre" for patients with ST-segment elevation myocardial infarction
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Optimal catchment area and primary PCI centre volume revisited: a single-centre experience in transition from high-volume centre to "mega centre" for patients with ST-segment elevation myocardial infarction. / Schoos, Mikkel Malby; Pedersen, Frants; Holmvang, Lene; Engstrøm, Thomas; Saunamaki, Kari; Helqvist, Steffen; Kastrup, Jens; Mehran, Roxana; Dangas, George; Jørgensen, Erik; Kelbæk, Henning; Clemmensen, Peter.
in: EUROINTERVENTION, Jahrgang 11, Nr. 5, 09.2015, S. 503-10.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Optimal catchment area and primary PCI centre volume revisited: a single-centre experience in transition from high-volume centre to "mega centre" for patients with ST-segment elevation myocardial infarction
AU - Schoos, Mikkel Malby
AU - Pedersen, Frants
AU - Holmvang, Lene
AU - Engstrøm, Thomas
AU - Saunamaki, Kari
AU - Helqvist, Steffen
AU - Kastrup, Jens
AU - Mehran, Roxana
AU - Dangas, George
AU - Jørgensen, Erik
AU - Kelbæk, Henning
AU - Clemmensen, Peter
PY - 2015/9
Y1 - 2015/9
N2 - AIMS: The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres, creating one mega centre serving 2.5 million inhabitants, and performing ~1,000 procedures/year.METHODS AND RESULTS: In this descriptive cohort study, we linked individual-level data from the national Central Population Register holding survival status with our in-hospital dedicated PCI database of baseline, organisational and procedural characteristics. Quality measures were treatment delays and 30-day all-cause mortality. In the three-year study period, 2,066 consecutive pPCIs were performed. After the fusion of the two centres, pPCI procedures increased by 102%, while door-to-balloon remained stable at 32 minutes. Up to 75.1% of patients were directly transferred by pre-hospital triage, of whom 82.7% had ECG-to-balloon <120 min, 92.6% had door-to-balloon <60 min. Thirty-day all-cause mortality remained low at 6.3%.CONCLUSIONS: This study challenges the stated maximal pPCI centre volume. The quality of a centre reflects governance, training, resources and pre-hospital triage, rather than catchment population and STEMI incidence, as long as a minimum volume is guaranteed. Resources can be utilised better by merging neighbouring centres, without negative effects on quality of care.
AB - AIMS: The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres, creating one mega centre serving 2.5 million inhabitants, and performing ~1,000 procedures/year.METHODS AND RESULTS: In this descriptive cohort study, we linked individual-level data from the national Central Population Register holding survival status with our in-hospital dedicated PCI database of baseline, organisational and procedural characteristics. Quality measures were treatment delays and 30-day all-cause mortality. In the three-year study period, 2,066 consecutive pPCIs were performed. After the fusion of the two centres, pPCI procedures increased by 102%, while door-to-balloon remained stable at 32 minutes. Up to 75.1% of patients were directly transferred by pre-hospital triage, of whom 82.7% had ECG-to-balloon <120 min, 92.6% had door-to-balloon <60 min. Thirty-day all-cause mortality remained low at 6.3%.CONCLUSIONS: This study challenges the stated maximal pPCI centre volume. The quality of a centre reflects governance, training, resources and pre-hospital triage, rather than catchment population and STEMI incidence, as long as a minimum volume is guaranteed. Resources can be utilised better by merging neighbouring centres, without negative effects on quality of care.
KW - Aged
KW - Catchment Area, Health
KW - Cohort Studies
KW - Delivery of Health Care/organization & administration
KW - Electrocardiography
KW - Emergency Medical Services
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Mortality
KW - Multivariate Analysis
KW - Myocardial Infarction/diagnosis
KW - Percutaneous Coronary Intervention/statistics & numerical data
KW - Proportional Hazards Models
KW - Registries
KW - Time-to-Treatment/statistics & numerical data
KW - Triage
U2 - 10.4244/EIJY14M11_07
DO - 10.4244/EIJY14M11_07
M3 - SCORING: Journal article
C2 - 25420787
VL - 11
SP - 503
EP - 510
JO - EUROINTERVENTION
JF - EUROINTERVENTION
SN - 1774-024X
IS - 5
ER -