Optimal catchment area and primary PCI centre volume revisited: a single-centre experience in transition from high-volume centre to "mega centre" for patients with ST-segment elevation myocardial infarction
Selected in EuroIntervention by S. Brugaletta
Schoos MM, Pedersen F, Holmvang L, Engstrøm T, Saunamaki K, Helqvist S, Kastrup J, Mehran R, Dangas G, Jørgensen E, Kelbæk H, Clemmensen P
EuroIntervention. 2015 Sep 22;11(5):503-10
LinkRead the article
Latest contributionsPulsatile iVAC 2L circulatory support in high-risk percutaneous coronary intervention Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the p... A tool for predicting the outcome of reperfusion in ST-elevation myocardial infarction using age, thrombotic burden and index of microcirculatory r...
What is known
The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. The present paper describes the organisation and quality of care after merging two high-volume centres, creating one mega centre serving 2.5 million inhabitants, and performing ~1,000 procedures/year.
- Quality measures were treatment delays and 30-day all-cause mortality.
- In the three-year study period, 2,066 consecutive pPCIs were performed.
- After the fusion of the two centres, pPCI procedures increased by 102%, while door-to-balloon remained stable at 32 minutes.
- Up to 75.1% of patients were directly transferred by pre-hospital triage, of whom 82.7% had ECG-to-balloon <120 min, 92.6% had door-to-balloon <60 min.
- Thirty-day all-cause mortality remained low at 6.3%
This is an interesting analysis reporting the effect of having a mega pPCI centre instead of 2-3 big centres on quality of treatment of STEMI patients. The main result is the finding that one mega pPCI centre with ~1,000 procedures per year, serving a catchment population of 2.5 million people, provides high-quality treatment, measured by internationally recognised standard quality parameters of pPCI, such as treatment delays and 30-day mortality. A mega pPCI centre represents in many countries a utopia, as politicians tend today to open many pPCI hospitals in order to cover all the small cities with the idea to reduce treatment delay and improve cost-effectiveness of pPCU.
Importantly, the present study goes in the opposite direction, showing that having a mega pPCI does not increase treatment delay, but conversely may reduce it. For this reason, it could be suggested that resources either can be used better by merging neighbouring pPCI centres, or they should be focused on efficient pre-hospital triage and in-hospital organisation, instead of having many pPCI centres. The paper is open for discussion.