Association of Physician Certification in Interventional Cardiology With In-Hospital Outcomes of Percutaneous Coronary Intervention

作者：Fiorilli Paul N; Minges Karl E; Herrin Jeph; Messenger John C; Ting Henry H; Nallamothu Brahmajee K; Lipner Rebecca S; Hess Brian J; Holmboe Eric S; Brennan Joseph J; Curtis Jeptha P^*

来源：Circulation, 2015, 132(19): 1816-1824.

DOI：10.1161/CIRCULATIONAHA.115.017523

• acute coronary syndromes
• acute myocardial infarction
• angioplasty
• catheter-based coronary interventions, stents
• chronic ischemic heart disease
• coronary revascularization
• health policy and outcome research
• registries

Background-The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010.
Methods and Results-We identified physicians who performed 10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups.
Conclusions-We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.

• 出版日期2015-11-10