Ten years of percutaneous coronary intervention in a low-volume military treatment facility: A quality improvement project

Background: The quality assurance of a percutaneous coronary intervention (PCI) program is particularly important when the volume of procedures is low in the center. Purpose: Determine predictors of the 30-day and long-term incidence of stent thrombosis, myocardial infarction, and death from any cause for all PCIs performed at Tripler Army Medical Center from January 2002 to June 2012. Methods: 929 PCIs were performed in 795 patients, resulting in an average PCI volume of 88 per year. Follow-up data were obtained for 99.8% of the patients at 30 days and for 83% at 3 years. Results: 18 deaths occurred during the first 30 days after PCI, with an observed morality rate of 2.26%. Multivariate logistic regression identified independent predictors of death at 30 days: stent thrombosis (OR 96), acute myocardial infarction, hemodynamic instability (OR 47), emergent (OR 17) or salvage (OR 28) PCI, and the need for preprocedural balloon pumping (OR 27). The long-term survival Kaplan-Meier estimates were 94% at 1 year and 90.4% at 3 years. Conclusion: The 30-day mortality was similar to the expected mortality based on the risk factors in the New York State Registry model, and long-term survival was comparable with that reported in large registries.