Association between operator volume and mortality in primary percutaneous coronary intervention

Krishnamurthy, Arvindra; Keeble, Claire; Anderson, Michelle A.; Burton-Wood, Natalie; Somers, Kathryn; Harland, Charlotte; Baxter, Paul D.; McLenachan, James M.; Blaxill, Jonathan; Blackman, Daniel J.; Malkin, Christopher J.; Wheatcroft, Stephen; Greenwood, John P

doi:10.1136/openhrt-2022-002072

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…9 Several studies demonstrated that higher-volume PCI operators and institutions have better clinical outcomes, including mortality. [9][10][11] In our study, versus 3.7 (0.6−7.3), respectively. 12 Our findings indicate that CTO PCI operators are often highly experienced in managing complications, which might be due to CTO operators performing more PCIs and more challenging cases, and experiencing complications more frequently.…”

Section: Pci Volume and Complicationssupporting

confidence: 40%

“…An analysis of the National Cardiovascular Data CathPCI registry performed between 2009 and 2015 found that the median number of annual PCIs per operator was 59 (21−106) 9 . Several studies demonstrated that higher‐volume PCI operators and institutions have better clinical outcomes, including mortality 9–11 . In our study, operators had higher PCI volume 205 (105−328) compared with the average interventionalist.…”

Section: Discussionmentioning

confidence: 51%

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International survey of chronic total occlusion percutaneous coronary intervention operators

Simsek,

Rempakos,

Kostantinis

et al. 2023

Cathet Cardio Intervent

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BackgroundContemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study.AimTo examine the contemporary CTO PCI practice.MethodsWe performed an online, anonymous, international survey of CTO PCI operators.ResultsFive hundred forty‐five CTO PCI operators and 190 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Almost half were from the United States (41%), most (93%) were men, and the median h/week spent in the hospital was 58. Median annual case numbers were 205 (150−328) for PCIs and 20 (5−50) for CTO PCIs. Almost one‐fifth (17%) entered CTO cases into registries, such as PROGRESS‐CTO (55%) and EuroCTO (20%). More than one‐third worked at academic institutions (39%), 31% trained dedicated CTO fellows, and 22% proctored CTO PCI. One‐third (34%) had dedicated CTO PCI days. Most (51%) never discharged CTO patients the same day, while 17% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 38% used intravascular imaging >90% of the time. Most used CTO scores including J‐CTO (81%), PROGRESS‐CTO (35%), and PROGRESS‐CTO complications scores (30%). Coronary artery perforation was encountered within the last month by 19%. On a scale of 0−10, the median comfort levels in treating coronary artery perforation were: covered stents 8.8 (7.0−10), coil embolization 5.0 (2.1−8.5), and fat embolization 3.7 (0.6−7.3). Most (51%) participants had a complication cart/kit and 25% conducted regular complication drills with catheterization laboratory staff.ConclusionContemporary CTO PCI practices vary widely. Further research on barriers to following the guiding principles of CTO PCI may improve patient outcomes.

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Section: Pci Volume and Complicationssupporting

confidence: 40%

Section: Discussionmentioning

confidence: 51%

International survey of chronic total occlusion percutaneous coronary intervention operators

Simsek,

Rempakos,

Kostantinis

et al. 2023

Cathet Cardio Intervent

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Retrospective Analysis of the Thai Percutaneous Coronary Intervention Registry: Impacts of Center Volume and Operator Experience on Outcomes

Chandavimol,

Limpijankit,

Srimahachota

et al. 2024

Cathet Cardio Intervent

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BackgroundPercutaneous coronary intervention (PCI) outcomes can vary due to various factors, including patient clinical condition, complexity of coronary lesions, expertise of operators, and quality of the PCI center.AimsThis study evaluated the influence of PCI center volume and operator experience on patient outcomes after the procedure.MethodsRetrospective data on demographic, clinical details, and outcomes for all patients undergoing PCI across 39 hospitals in Thailand from 2018 to 2019 were retrieved. PCI center volume was categorized based on annual number of interventions: low (< 200), intermediate (200–499), and high (≥ 500). Operator experience was assessed by years of practice (low [< 5] and high [≥ 5]) and the number of PCI cases performed annually (low [< 75] and high [≥ 75]). The evaluated PCI outcomes were: PCI failure; procedural complications; PCI‐related in‐hospital mortality; 1 year post‐intervention all‐cause mortality.ResultsA total of 19,701 patients who underwent PCI were included in the analysis, of whom 17,432 had follow‐up data available after 1 year. Of these, 58.1% presented with either ST‐elevation or non‐ST elevation myocardial infarction/unstable angina, while 41.9% had stable CAD. Nearly half of the patients had triple‐vessel or left‐main disease, and 8.7% presented with cardiogenic shock. The percent with PCI failure, procedural complications, PCI‐related in‐hospital death, and 1‐year all‐cause mortality were 4.9%, 5.1%, 2.7%, and 11.8%, respectively. Despite patients in higher‐risk profiles being treated at high‐volume PCI centers and by experienced operators, there were no significant differences in PCI failure, PCI‐related in‐hospital mortality nor 1‐year all‐cause mortality compared to those treated at low or intermediate volume PCI centers. However, high‐volume PCI centers had procedural complications more frequently (4.7%) than did intermediate (3.9%) and low‐volume (2.5%) centers (p < 0.001). After adjusting for confounding factors, no significant associations were found between PCI center volume and PCI outcome. Similarly, no significant relationship was found between operator experience and procedural complications, nor 1‐year all‐cause mortality. Nevertheless, operators with more years of practice were associated with lower PCI‐related in‐hospital mortality (odds ratio [95% CI] of 0.75 (0.57, 0.98); p < 0.038). Additionally, operators conducting a higher number of PCIs annually tended to have less PCI failures (odds ratio [95% CI] of 0.76 (0.57, 1.01); p = 0.062).ConclusionA center's PCI volume did not significantly impact PCI outcome. In contrast, operator experience did impact outcomes. This result highlights areas for improvement and can help reform strategies for national PCI systems at both center and operator levels.

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PCI Facility Openings and Closures

Bailey

2023

JACC: Cardiovascular Interventions

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Association between operator volume and mortality in primary percutaneous coronary intervention

Cited by 3 publications

References 33 publications

International survey of chronic total occlusion percutaneous coronary intervention operators

International survey of chronic total occlusion percutaneous coronary intervention operators

Retrospective Analysis of the Thai Percutaneous Coronary Intervention Registry: Impacts of Center Volume and Operator Experience on Outcomes

PCI Facility Openings and Closures

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