Coronary angiogram, showing the circulation in the left main coronary artery and its branches via Wikimedia Commons
Physicians should not be judged solely on their patient mortality rates for percutaneous coronary intervention procedures because the rate varies considerably over time. Those were the findings of a new study published in JACC: Cardiovascular Interventions.
PCI is performed to relieve the symptoms of coronary heart disease or to lessen heart damage during or after a heart attack. It's among the most common hospital-based major interventional procedures performed in the U.S., according to a study published in JAMA.
For the study, the researchers evaluated data from the National Cardiovascular Data Registry CathPCI Registry. Their objective was to determine how many physicians had mortality rates outside of the normal range.
There were 3,760 physicians included in the study, who performed a total of 2,343,693 PCI procedures. The researchers adjusted for a number of factors including how sick the patients were.
They uncovered that 6.5 percent of the physicians had mortality rates above the normal range and 4.1 percent had rates lower than the normal range.
Dr. Jacob Doll, cardiologist at the University of Washington and lead author of the study, said that PCI mortality rates for individual physicians could be used to improve the safety of the procedure. But he doesn't think it's ready for widespread use as a publicly reported measure or to influence payment.
The mortality rate for a PCI procedure is rare — for every 100 procedures only slightly more than one percent die. Any given physician could have two or four deaths one year and then none the next.
"This may be further confounded by the low number of deaths that can be ascribed to the procedure, and makes it challenging to know whether these differences are actually due to the care received," Doll said in a statement.
In an accompanying editorial, Dr. Michael McDaniel of Emory University School of Medicine stated that physicians may avoid treating the highest-risk patients if they're concerned about their mortality rate being report publicly.
