Percutaneous Coronary Interventions (PCI) in New York State 2005-2007
New York, NY (Vocus) April 30, 2010
In a statewide study, The Mount Sinai Hospital in Manhattan – along with two of its doctors – has been singled out by the New York State Department of Health as the hospital with the most successful record in performing angioplasty, a technique used to clear blocked coronary arteries. This ranking demonstrates the unparalleled skills of the interventional cardiologist team and the truly exceptional quality of patient care that takes place daily at Mount Sinai.
In the report released on April 22, “Percutaneous Coronary Interventions (PCI) in New York State 2005-2007,” the Department of Health provides statistics on deaths within 30 days following PCI, more commonly known as angioplasty. In the three-year period, 53 non-federal New York hospitals were performing the procedure, and only one of them – Mount Sinai – received a “double-star” rating for a risk-adjusted mortality rate significantly lower than the statewide rate in both emergency cases and overall cases.
Data collected by the New York State Department of Health show that Mount Sinai performed 13,030 PCIs from 2005 to 2007. The risk-adjusted mortality rate from PCI at Mount Sinai was 0.64 percent, the lowest in the state.
“Mount Sinai is the busiest Cardiac Catheterization Laboratory in the state and treats the most complex cases, which makes the low mortality rating even more important,” said Samin K. Sharma, MD, Director of the Cardiac Catheterization Laboratory. “We are committed to providing the best patient care, and are proud to have achieved such a stellar rating in patient safety.”
Dr. Sharma and Dr. Annapoorna Kini, Associate Director of the Cardiac Catheterization Laboratory, were two of only five doctors who were awarded individual double-star ratings for significantly lower risk-adjusted mortality rates than the statewide average. Dr. Sharma achieved a 0.41 percent rating in both non-emergency cases and overall cases, while Dr. Kini achieved a 0.43 percent rating for overall cases. Their success confirms their status as world-class physicians and represents Mount Sinai’s unwavering commitment to providing superior outcomes for it patients
Kenneth L. Davis, MD, President and Chief Executive Officer of The Mount Sinai Medical Center, said, “Drs. Sharma and Kini are exemplary physicians and leaders. Under their direction, Mount Sinai’s Cath Lab team has earned a reputation that exceeds that of any other institution.”
The Mount Sinai Hospital performed by far the most angioplasties of any hospital – more than 13,000 – in the three-year period studied in the Department of Health report, and only one other doctor statewide came close to performing the number of procedures completed by Drs. Sharma and Kini, who performed 3,722 and 2,780 angioplasties, respectively. That volume reflects the hospital’s expertise and experience in the procedure, and because of its ability to successfully handle complex cases, about a third of its patients are referred from outside Mount Sinai’s patient base.
“Despite the high volume of cardiac patients we treat, our team consistently provides top-notch patient care. The report’s rating exemplifies our dedication to quality and safety, and we look forward to making further improvements next year," Dr. Kini adds.
The Cath Lab’s low mortality rate can be attributed to the seamless technical skills of its doctors and the attention they pay to minute details before, during, and after each procedure. There is a more than 150-page comprehensive procedure manual detailing specific protocols for every aspect of a procedure for everyone involved, from the nursing staff to the attending physicians. It outlines not only standard procedures but also protocols for dealing with complications that might occur, such as a patient kidney malfunction or allergic reaction. What’s more, each month, the entire staff meets to discuss and analyze any new issues that may have arisen, and the manual is updated to address them.
Percutaneous Coronary Intervention is a minimally invasive technique used to treat patients with diseased or blocked coronary arteries. The procedure involves threading a catheter with a tiny balloon from an artery in the groin to an occluded vessel in the heart. The clinicians inflate the balloon so they may clear the artery and then insert a stent to secure the open vessel. When the blockage is calcified, it makes the artery difficult to open. In those cases, the Mount Sinai Cath Lab has become adept at using the Rotablator, a high-speed spinning device that breaks up and clears the calcification so the balloon can open the artery. The Rotablator, or rotational atherectomy, is used in 9-10 percent of angioplasties at Mount Sinai, versus just 1-2 percent of cases nationwide.
“That method makes a complex case simple,” Dr. Sharma noted. “And because of our expertise in handling difficult angioplasty procedures, we have developed an excellent reputation, so that other doctors and hospitals send their complex cases to us. We like those cases too, because we know we can do a good job and make a difference for those patients.”
The Department of Health has been assessing angioplasty results of hospitals across the state for more than 15 years, with the first PCI report released in 1996. Its report analyzes statistics including observed mortality rates and expected mortality rates for each hospital and each doctor, and computes a risk-adjusted mortality rate that accounts for providers treating more or fewer high-risk patients. A “confidence interval” is also calculated to adjust outcomes based on the volume of procedures performed. The Mount Sinai Hospital and Dr. Sharma have received double-stars for significantly lower than average mortality several times in the last ten reports. Since the latest study, The Mount Sinai Hospital has performed close to 15,000 angioplasties and it continues to maintain excellent mortality rates.
“The rating of our Cardiac Catheterization Laboratory is exceptional but not surprising, as we have a team of the best interventionalists in the world,” said Wayne Keathley, President & Chief Operating Officer, The Mount Sinai Hospital. “Mount Sinai is committed to patient safety and works tirelessly to ensure that all patients experience the best outcome with a low incidence of complications. The performance of Drs. Sharma, Kini, and their team embody this commitment, and they have raised the bar internationally for cardiac care.”
The complete New York State Department of Health PCI report is available at http://www.health.state.ny.us/statistics/diseases/cardiovascular/docs/pci_2005-2007.pdf.
About The Doctors
Dr. Samin K. Sharma is Professor of Medicine (Cardiology) at Mount Sinai Medical Center, Director of the Cath Lab and Intervention, and Co-Director of the Cardiovascular Institute, Mount Sinai Heart. He performs more than 1,500 complex coronary interventions annually (the highest in the country), and according to New York State Department of Health reports, he has the highest angioplasty success rate (mortality less than 0.3 percent) for any interventional cardiologist in the state since 1994.
Dr. Sharma serves on the Cardiac Advisory Board of New York State for coronary interventions, and received the Governor’s Award of Excellence in 2006 for his outstanding contributions to medicine. Under his directorship, the Live Symposium of Complex Coronary Cases has been held annually since 1998, bringing together more than 500 doctors, nurses, and technicians to learn about the latest developments in interventional cardiology. He has received “Best Doctors” status from U.S. News and World Report and has been included in “Top Physicians” lists by Consumer Research Council of America and Castle Connelly magazines.
Dr. Annapoorna Kini is Associate Professor of Medicine (Cardiology) at Mount Sinai Medical Center and Associate Director of the Cath Lab. She performs more than 1,000 coronary interventions annually (the highest number by a female interventionalist in the U.S.) with an extremely low complication rate of less than 0.3 percent, and is well known for successfully performing complex coronary interventions in patients with advanced heart disease with excellent long-term results. Many of these high-risk patients require the support of a heart-assist (Tandem Heart and Impella) device and Dr. Kini has become a national expert in the use of this lifesaving technology.
Dr. Kini serves as Director of Mount Sinai’s Interventional Cardiology Fellowship Program, and is Co-Director of the Live Symposium of Complex Coronary Cases. She also serves as the site Principal Investigator for numerous multi-center trials, including the National Institutes of Health (NIH) sponsored COPES trial.
About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of few medical schools embedded in a hospital in the United States. It has more than 3,400 faculty in 32 departments and 15 institutes, and ranks among the top 20 medical schools both in National Institute of Health funding and by U.S. News & World Report. The school received the 2009 Spencer Foreman Award for Outstanding Community Service from the Association of American Medical Colleges.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation’s oldest, largest and most-respected voluntary hospitals. In 2009, U.S. News & World Report ranked The Mount Sinai Hospital among the nation’s top 20 hospitals based on reputation, patient safety, and other patient-care factors. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 530,000 outpatient visits took place.
For more information, visit http://www.mountsinai.org.