Clinical outcomes in a community-based single operator coronary interventional program.

BACKGROUND Physicians who perform fewer than 75 coronary interventional procedures annually and centers where fewer that 200 procedures are performed annually are considered to be low-volume and likely to have higher procedural risk and suboptimal outcomes. METHODS This was assessed in a retrospective analysis of clinical outcomes in 559 patients who underwent multi-device coronary interventions from 1994 through 2002 (prior to and during the bare metal stent era) performed by a single operator in a community hospital setting with on-site cardiac surgical services. RESULTS ST- and non-ST-elevation myocardial infarction was present in 36.5% and 10.2% of the population, respectively, with 12.3% of ST-elevation myocardial infarction patients presenting with acute cardiogenic shock. Mortality in all patient subsets was less than 1% when patients with ST-elevation myocardial infarction and cardiogenic shock were excluded. The 6-month target lesion revascularization rate for all devices and in all patient subsets during the study period was 9.1%, and for those treated with coronary stents, the rate was 7.8%. From 1999 through 2002, the rates were 2.1% and 1.9%, respectively. CONCLUSIONS A low-volume coronary interventional program can achieve angiographic percutaneous coronary interventional success rates and major adverse cardiac events and the need for target lesion revascularization comparable to those in high-volume major cardiac referral centers. These results were obtained even when high-risk patients with ST-elevation myocardial infarction were not excluded from the analysis.