Osamu Iida1, Mitsuyoshi Takahara2, Yasutaka Yamauchi3, Yoshiaki Shintani4, Teruyasu Sugano5, Yoshito Yamamoto6, Daizo Kawasaki7, Hiroyoshi Yokoi8, Akira Miyamoto3, Toshiaki Mano1, Masato Nakamura9. 1. Cardiovascular Center, Kansai Rosai Hospital. 2. Department of Metabolic Medicine, Osaka University Graduate School of Medcine. 3. Cardiovascular Center, Takatsu General Hospital. 4. Department of Cardiology, Shin-Koga Hospital. 5. Department of Cardiovascular Medicine, Yokohama City University Hospital. 6. Department of Cardiovascular Medicine, Iwaki Kyoritsu General Hospital. 7. Cardiovascular Division, Department of Internal Medicine, Morinomiya Hospital. 8. Cardiovascular Center, Fukuoka Sanno Hospital. 9. Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center.
Abstract
AIM: To investigate the impact of institutional volume on clinical outcomes after aortoiliac (AI) stenting in patients with symptomatic peripheral artery disease (PAD). METHODS: We analyzed the clinical database from the Observational prospective Multicenter registry study on the Outcomes of peripheral arTErial disease patieNts treated by AngioplaSty tHerapy in the aortoIliac artery (OMOTENASHI) registry. The volume of each institution was evaluated as the number of endovascular therapy (EVT) procedures performed in 2 years (2014-2015). High-volume centers were defined as being in the highest tertile of the procedural volume (≥ 611 EVT procedures in 2 years). Clinical outcomes, treatment strategies, and endovascular procedures were compared between high- and low-volume centers using a propensity score matching. RESULTS: The propensity score matching extracted 236 pairs of patients (as many patients treated at high-volume centers and 519 patients treated at low-volume centers), with no remarkable intergroup differences in the baseline characteristics. Patients treated at high-volume hospitals had a significantly lower 12-month restenosis rate than that of patients treated at low-volume hospitals (6.5% vs. 15.8%, P=0.032), although comparable outcomes between the two groups included the technical success rate (99.6% vs. 99.8%, P=0.58) and the rate of 30-day major adverse events (0.4% vs. 0.8%, P=0.59). CONCLUSION: Institutional volume was associated with the 12-month restenosis rate after AI stenting for PAD, although comparable perioperative outcomes were also observed between high-volume and low-volume hospitals.
AIM: To investigate the impact of institutional volume on clinical outcomes after aortoiliac (AI) stenting in patients with symptomatic peripheral artery disease (PAD). METHODS: We analyzed the clinical database from the Observational prospective Multicenter registry study on the Outcomes of peripheral arTErial diseasepatieNts treated by AngioplaSty tHerapy in the aortoIliac artery (OMOTENASHI) registry. The volume of each institution was evaluated as the number of endovascular therapy (EVT) procedures performed in 2 years (2014-2015). High-volume centers were defined as being in the highest tertile of the procedural volume (≥ 611 EVT procedures in 2 years). Clinical outcomes, treatment strategies, and endovascular procedures were compared between high- and low-volume centers using a propensity score matching. RESULTS: The propensity score matching extracted 236 pairs of patients (as many patients treated at high-volume centers and 519 patients treated at low-volume centers), with no remarkable intergroup differences in the baseline characteristics. Patients treated at high-volume hospitals had a significantly lower 12-month restenosis rate than that of patients treated at low-volume hospitals (6.5% vs. 15.8%, P=0.032), although comparable outcomes between the two groups included the technical success rate (99.6% vs. 99.8%, P=0.58) and the rate of 30-day major adverse events (0.4% vs. 0.8%, P=0.59). CONCLUSION: Institutional volume was associated with the 12-month restenosis rate after AI stenting for PAD, although comparable perioperative outcomes were also observed between high-volume and low-volume hospitals.
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Authors: Hans Krankenberg; Thomas Zeller; Maja Ingwersen; Josefin Schmalstieg; Hans Martin Gissler; Sigrid Nikol; Iris Baumgartner; Nicolas Diehm; Estell Nickling; Stefan Müller-Hülsbeck; Rainer Schmiedel; Giovanni Torsello; Willibald Hochholzer; Christian Stelzner; Klaus Brechtel; Wulf Ito; Ralph Kickuth; Erwin Blessing; Marcus Thieme; Jaroslaw Nakonieczny; Thomas Nolte; Ragnar Gareis; Harald Boden; Sebastian Sixt Journal: JACC Cardiovasc Interv Date: 2017-08-28 Impact factor: 11.195
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