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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis

Review published: 2010.

Bibliographic details: Post PN, Kuijpers M, Ebels T, Zijlstra F.  The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis. European Heart Journal 2010; 31(16): 1985-1992. [PubMed: 20511324]

Quality assessment

This review concluded that hospitals with a high volume of procedures reported lower in-hospital mortality for percutaneous coronary intervention or coronary artery bypass grafting than lower-volume hospitals. The presented evidence appears to support the authors? conclusions, but lack study quality reporting make it difficult to judge their reliability and potentially limited applicability outside the USA should be taken into account. Full critical summary


AIMS: Although various studies reported better outcomes in centres performing a high volume of procedures of coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCIs), it is unclear how strong this relation is and whether it pertains to today's practice.

METHODS AND RESULTS: Medline, Embase, and conference reports were searched for studies reporting the effect of high volume of CABG or PCI on in-hospital mortality, adjusted for differences in case-mix. Of 140 potentially relevant papers, 15 were included, 2 of which reported data on both CABG and PCI. Meta-analysis of 10 studies on PCI, comprising 1 322 342 patients in 1746 hospitals, indicated an odds ratio (OR) of in-hospital mortality for patients treated in a high-volume hospital of 0.87 (95% confidence interval (CI) 0.83-0.91) compared to those treated in a low-volume hospital. The 7 CABG studies taken together, comprising 1 470 990 patients in 2040 hospitals, also revealed a significant effect of high volume (OR 0.85; CI 0.79-0.92). A differential effect for specific cut-off points could not be identified. Meta-regression did not show notable changes in the effect size over the years.

CONCLUSIONS: Patients undergoing CABG or PCI in a high-volume hospital exhibit lower in-hospital mortality than those treated at low-volume hospitals. Our meta-analysis does not support the view that this relation has attenuated over time.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2013 University of York.

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