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Background: Variation in outcomes after percutaneous coronary interventions (PCI) may reflect differences in quality of care. To date, however, we lack a methodology to monitor and improve national hospital 30-day mortality rates among patients undergoing PCI.Methods and Results: We developed hierarchical logistic regression models to calculate hospital risk-standardized 30-day all-cause PCI mortality rates. Due to differences in risk, patients were divided into 2 cohorts: those with ST-segment elevation myocardial infarction or cardiogenic shock, and those with no ST-segment elevation myocardial infarction and no cardiogenic shock. The models were derived using 2006 data from the CathPCI Registry linked with administrative claims data, and validated using comparable 2005 data. In the derivation cohort of the ST-segment elevation myocardial infarction or shock model (n=15 123), the unadjusted 30-day mortality rate was 9.2%. The final model included 13 variables with the observed mortality rates ranging from 1.4% to 40.3% across deciles of the predicted patient mortality rates. The 25th and 75th percentiles of the risk-standardized mortality rate were 8.5% and 9.7%, with 5th and 95th percentiles of 7.6% and 11.0%. In the derivation cohort of the no ST-segment elevation myocardial infarction and no shock model (n=110 529), the unadjusted 30-day mortality rate was 1.4%. The final model included 16 variables with the observed predicted mortality rates ranging from 0.1% to 7.0% across deciles of the predicted patient mortality rates. The 25th and 75th percentiles of the risk-standardized mortality rate across 612 hospitals were 1.3% and 1.6%, with 5th and 95th percentiles of 1.0% and 2.0%.Conclusions: These National Quality Forum endorsed registry-based models produce estimates of hospital risk-standardized mortality rates for patients undergoing PCI. [ABSTRACT FROM AUTHOR]

The article discusses research on the use of intra-aortic balloon pumps (IABP) in hospitals among high risk percutaneous coronary intervention (PCI) patients and its impact on mortality. High risk PCI has many features, including unprotected left main artery as the primary target. Variaion in the use of IABP did not have impact on in-hospital mortality.

The article discusses a study on the use of hierarchical regression models in assessing the rates of risk-standardized mortality and readmission of patients with heart failure in hospitals identified in the "America's Best Hospitals" ranking by the periodical "U.S. News & World Report" and in those non-ranked facilities. The study noted there was a reduced mean rate of in-hospital mortality in ranked hospitals, compared to non-ranked ones. It is said that ranked hospitals have not shown enough evidence of superiority for readmission.