Hospital volume and mortality relation in PCI - Is there a need for modification of ACC/AHA percutaneous coronary intervention guidelines in Asia?

The relationship between hospital volume and outcome relation in percutaneous coronary intervention (PCI) is important for patients, policy makers and referring physicians. Hospital volume is the explicit criterion for health care purchasers recommended by Leapfrog group. In accordance with current American College of Cardiology/American Heart Association (ACC/AHA) percutaneous coronary intervention (PCI) clinical practice guidelines, Leapfrog has established a minimum institutional volume requirement of 400 cases per year for hospitals offering PCI (1, 2). For these reason, centralization of PCI cases in core facilities has been advocated. This volume threshold is mainly based on studies originating from USA in the 1980s and 1990s which showed increased PCI mortality for patients treated at hospitals with annual volumes <400 cases (3, 4). However, there have been many changes in recent years in PCI practice by widespread use of low profile balloons, stents, glycoprotein IIb/ IIIa inhibitors and intra-aortic balloon pumps. These changes and widespread PCI education opportunities increased interventional cardiologists’ abilities and self-confidence, which raise the possibility that currently recommended hospital PCI volume threshold of 400 cases may no longer be appropriate.