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The Association of Hospital Volume of Percutaneous Coronary Intervention with Cardiac Mortality

 Jae-Hyun Kim  ;  Jang-Mook Kim  ;  Eun-Cheol Park 
 Korean Journal of Health Policy and Administration (보건행정학회지), Vol.28(2) : 168-177, 2018 
Journal Title
 Korean Journal of Health Policy and Administration (보건행정학회지) 
Issue Date
Angina Pectoris ; Coronary Disease ; Emergency Service, Hospital ; Health Policy ; Hospitals, High-Volume ; Hospitals, Low-Volume ; Humans ; Mortality* ; Myocardial Infarction ; National Health Programs ; Percutaneous Coronary Intervention* ; Proportional Hazards Models
Coronary heart disease ; Mortality ; Percutaneous coronary intervention
BACKGROUND: This study investigates the potential volume and outcome association of coronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) using a large and representative sample. METHODS: We used a National Health Insurance Service-Cohort Sample Database from 2002 to 2013 released by the Korean National Health Insurance Service. A total of 8,908 subjects were analyzed. The primary analysis was based on Cox proportional hazards models to examine our hypothesis. RESULTS: After adjusting for confounders, the hazard ratio of thirty-day and 1-year mortality in hospitals with a low volume of CHD patients with PCI was 2.8 and 2.2 times higher (p=0.00) compared to hospitals with a high volume of CHD patients with PCI, respectively. Thirty-day and 1-year mortality of CHD patients with PCI in low-volume hospitals admitted through the emergency room were 3.101 (p=0.00) and 2.8 times higher (p=0.01) than those in high-volume hospitals, respectively. Only 30-day mortality in low-volume hospitals of angina pectoris and myocardial infarction patients with PCI was 5.3 and 2.4 times those in high-volume hospitals with PCI, respectively. CONCLUSION: Mortality was significantly lower when PCI was performed in a high-volume hospital than in a low-volume hospital. Among patients admitted through the emergency room and diagnosed with angina pectoris, total PCI volume (low vs. high) was associated with significantly greater cardiac mortality risk of CHD patients. Thus, There is a need for better strategic approaches from both clinical and health policy standpoints for treatment of CHD patients.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
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