Overall, the new findings are "really good news for patients in general, because it means that whatever hospital you go to, the result is likely to be good," said Dr. Issam D. Moussa, associate professor of medicine and director of the endovascular service at Weill Medical College of Cornell University, New York City, and a spokesman for the Society for Cardiovascular Angiography and Interventions.
The study results also confirm current guidelines about emergency treatment for heart attacks, Moussa said. "When they pick you up, they should take you to the nearest hospital," he said. "This study doesn't change that."
But he also said the findings of the study were not unshakable because of the relatively small number of people treated in low-volume hospitals.
"Low-volume hospitals [in the study] included only 3,000 patients," Moussa said. "Because of that low number, the results cannot be conclusive."
The difference between in-hospital death rates found in the study might have been statistically significant had the numbers been higher, he said. And the study also excluded about 120 hospitals because they reported too few primary angioplasties, Moussa said.
The study also looked only at in-hospital deaths, Bhatt noted. "If we looked at longer-term outcomes, differences might emerge," he said.
Still, the study casts some doubt on the notion that in cardiology, practice makes perfect, Bhatt noted. "Within the range we studied and the kinds of hospitals we studied, the difference was not there," he said.
In a related study published in the same issue o
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