{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:21:30Z","timestamp":1761862890644},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2009,11]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            American College of Cardiology (ACC) guidelines state that percutaneous coronary interventions (PCI) be performed at centers and by operators with high-volume (&gt;400 yearly\/center) whose historical and current risk-adjusted outcomes statistics are comparable to those reported in large registries. Tripler Army Medical Center is a low-volume treatment facility but has a geographic need and special mission requirement for providing this service.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            We computed 30-day incidence of stent thrombosis, need for repeat revascularization, and all-cause mortality for all PCIs performed at Tripler from January 2002 through June 2008. The New York State Registry regression model was selected among 3 risk-adjustment models that we assessed in our patients. This model was used to compute expected mortality rate based on patient risk factors. The 30-day incidence of stent thrombosis and repeat revascularization was also determined, and the long-term incidence of these events was estimated with the Kaplan\u2013Meier method as was survival. For all 546 PCI procedures, 30-day mortality was 1.47%, the incidence of stent thrombosis 2.1%, the incidence of any repeat revascularization 5.1%, and the combined event rate 5.9%. Based on risk factors used in the New York State Registry, our expected mortality was 1.93% and not significantly different from the observed rate. Although survival at 1 and 3 years appeared comparable with benchmarks at 94.6% and 89.3%, as did repeat revascularization rates at 13.0% and 21.4%, the incidence of stent thrombosis was regarded as high whether the definition included possible cases (3.2% and 3.9%) or only those regarded as definite or probable (2.7% and 3.1%). We did not identify any remediable risk factors for stent thrombosis, nor were we able to identify significant differences by year or by operator. However, visual inspection of a plot of deciles of New York State risk of death demonstrated 2 outlier cases among the 8 who died, who could have been considered candidates for thorough peer review.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusion\u2014<\/jats:italic>\n            <\/jats:bold>\n            We recommend other low-volume interventional programs enter all patients undergoing PCI into a database, their own local registry even if not a national one such as the American College of Cardiology National Cardiovascular Data Registry, obtain information about survival and cardiac events during follow-up, compute and risk-adjust in-hospital or 30-day mortality, and use the objective assessment of risk in individual patients to identify outliers when outcome is adverse, and possibly as a means of triaging patients to appropriate therapy before choosing PCI.\n          <\/jats:p>","DOI":"10.1161\/circoutcomes.109.867077","type":"journal-article","created":{"date-parts":[[2009,11,17]],"date-time":"2009-11-17T23:39:56Z","timestamp":1258501196000},"page":"671-677","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Percutaneous Coronary Intervention Outcomes in a Low-Volume Center"],"prefix":"10.1161","volume":"2","author":[{"given":"Kimberly M.","family":"Kenney","sequence":"first","affiliation":[{"name":"From the Tripler Army Medical Center, Tripler AMC, Hawaii."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitchell C.","family":"Marzo","sequence":"additional","affiliation":[{"name":"From the Tripler Army Medical Center, Tripler AMC, Hawaii."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas R.","family":"Ondrasik","sequence":"additional","affiliation":[{"name":"From the Tripler Army Medical Center, Tripler AMC, Hawaii."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Wisenbaugh","sequence":"additional","affiliation":[{"name":"From the Tripler Army Medical Center, Tripler AMC, Hawaii."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","first-page":"156","volume":"13","year":"2006","unstructured":"Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB III, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO. ACC\/AHA\/SCAI 2005 guideline update for percutaneous coronary intervention\u2014summary article: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (ACC\/AHA\/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation. 2006; 13: 156\u2013175.","journal-title":"Circulation"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.09.070"},{"key":"e_1_3_2_3_2","unstructured":"NCDR CathPCI Registry Risk-Adjustment Methodology. 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