Advanced Technology for PCI
Drug Eluting Stents: Restenosis (renarrowing or reblockage) of an opened coronary artery after PCI with a bare-metal stent occurs at rates of up to 30 percent. This restenosis may require one or more additional procedures to reopen the artery. (The New England Journal of Medicine, October 2, 2003: 349(14); 1315-1323). The use of drug-eluting stents (stents containing medication that helps prevent restenosis by gradually releasing the medication over time) has been shown to decrease restenosis after PCI and stent placement, as well as to decrease the need for additional procedures to reopen an artery.
Cardiologists who perform PCI procedures at Brigham and Women's Hospital use drug-eluting stents in appropriate patient situations. Another advanced technique available is the use of ventricular assist devices, which support the heart during extremely complex procedures.
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Annual PCI Procedure Volume
The Leapfrog Group has recommended that hospitals which perform PCI should perform a minimum of 400 procedures per year in order to maintain the highest level of quality (Surgery,September 2001: 130; 415-422). The American College of Cardiology (ACC) Foundation and the American Heart Association, Inc (AHA) 2005 guidelines for PCI have a similar recommendation.
Brigham and Women's Hospital's interventional cardiologists performed 1257 PCIs in 2006, vastly exceeding the AHA/ACC guidelines recommending that hospitals perform at least 400 procedures/year.
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Inpatient Mortality Rate
Mortality rate (measured as a percentage) provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate. Based on a large sample of hospitals (data from the American College of Cardiology, aka ACC), the national average mortality rate for PCI is 1.2%. Because BWH patients are generally more sick than the average patient, our expected mortality rate for PCI is 1.4% (as estimated by the ACC).
Mortality rate for PCI also depends on the circumstances under which the procedure is performed. In general, patients in the midst of a heart attack, or who are in shock, have a higher risk of death than other patients. At BWH, the mortality rate for heart attack/shock PCI PCI procedures is 6.85%, whereas the mortality rate for all other PCI procedures is only 0.65%. These rates are based on the 12-month period ending 9/30/2006.
The inpatient mortality rate for PCI at Brigham and Women's Hospital is 1.3%, which is better than the expected (1.4%) rate. All rates refer to the 12-month period ending 12/31/2006.
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Door-to-Balloon Time (Hospital Arrival to PCI Interval)
In heart attack patients, the longer that blood does not flow to the heart muscle, the more likely there is to be damage to that muscle. PCI is considered the most effective method of restoring blood flow. Minimizing the time between patient arrival and PCI can reduce adverse consequences and reduce the amount of muscle destroyed by the attack. Because of a balloon-like device used in PCI, this interval is called "door-to-balloon time". National agencies recommend that the waiting time be no more than 90 minutes.
At Brigham and Women's Hospital, the median door-to-balloon time was 79 minutes in fiscal year 2007 (Oct '06 to Sept '07); 54% of patients had a door-to-balloon time under 90 minutes . These rates include primary and facilitated emergency (not elective) procedures.
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Data Bank Reporting
The Leapfrog Group has requested that all hospitals that perform PCI join the American College of Cardiology - National Cardiovascular Data Registry Data Bank in order to report performance data (American Heart Journal, December 2003: 146(6); 932-934).
Brigham and Women's Hospital reports all PCI data to the American College of Cardiology - National Cardiovascular Data Registry Data Bank as requested by the Leapfrog Group.
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