Hospital Volume and Cardiac Complications of Endomyocardial Biopsy: A Retrospective Cohort Study of 9508 Adult Patients Using a Nationwide Inpatient Database in Japan

Abstract

BACKGROUND: Recent research on complications with endomyocardial biopsy (EMB) has been based on single-center or 2-center studies in high-volume cardiovascular centers. No study has examined the association between hospital volume and the complication rate after EMB. HYPOTHESIS: Hospital volume is inversely associated with cardiac complication rate after EMB. METHODS: Using the Diagnosis Procedure Combination database in Japan, we identified inpatients aged ≥20 years who underwent EMB under fluoroscopic guidance. We assessed cardiac complications requiring the following urgent procedures on the day of EMB or the day after: pericardiocentesis, surgical repair, and temporary pacing. RESULTS: Among 9508 eligible patients in 491 hospitals (male, 68%; mean age, 57.0 years), dilated cardiomyopathy was the most frequently diagnosed condition (35.4%). Twenty-four patients (0.25%) required pericardiocentesis on the day of EMB. Three patients (0.03%) underwent surgical repair on the day of EMB or the day after. Sixty-three patients (0.70%) required temporary pacing on the day of EMB. Higher hospital volume was associated with lower rates of pericardiocentesis (low volume, 0.4%; medium volume, 0.2%; high volume, 0.1%; P for the trend test, 0.019) and temporary pacing (low volume, 1.0%; medium volume, 0.7%; high volume, 0.2%; P for the trend test, < 0.001). In a multivariable logistic regression analysis, high hospital volume was significantly associated with a lower rate of the composite outcome of the procedures (reference, low volume; adjusted odds ratio, 0.22; 95% confidence interval, 0.08-0.62, P = 0.004). CONCLUSIONS: Serious cardiac complications of EMB were rare, but higher hospital volume was associated with lower complication rate.