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

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 -