Impact of Operator Experience and Volume on Outcomes After Left Main Coronary Artery Percutaneous Coronary
Bo Xu1, Björn Redfors2, Yuejin Yang1
1Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
Insights
Experienced operators performing left main coronary artery percutaneous coronary intervention (LM PCI) significantly improve patient prognosis. High-volume LM PCI experience is crucial for better short- and long-term outcomes in this complex procedure.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Health Services Research
Background:
- Left main coronary artery (LM) percutaneous coronary intervention (PCI) is a complex procedure with potential risks.
- Operator experience is hypothesized to influence patient outcomes after LM PCI.
Purpose of the Study:
- To evaluate the impact of operator experience on prognosis following LM PCI.
- To determine if high-volume LM PCI operators achieve better patient outcomes.
Main Methods:
- Retrospective analysis of 1,948 patients undergoing unprotected LM PCI.
- Comparison of outcomes between patients treated by experienced (≥15 LM PCIs/year for 3 years) and less experienced operators.
- Utilized Kaplan-Meier estimates and Cox proportional hazards models.
Main Results:
- Patients treated by experienced operators had lower cardiac death risks at 30-day and 3-year follow-up.
- Operator experience improved the predictive discrimination of risk models like SYNTAX score.
- No significant interaction found between operator experience and specific procedural factors.
Conclusions:
- High-volume, experienced operators are associated with better short- and long-term prognoses after LM PCI.
- Operator experience is a critical factor in the success of complex LM PCI procedures.
Objectives:
The aim of this study was to assess the impact of operator experience on prognosis after left main coronary artery (LM) percutaneous coronary intervention (PCI).
Background:
LM PCI can be technically challenging and potentially risky considering the amount of supplied myocardium.
Methods:
Consecutive patients who underwent unprotected LM PCI at a single institution were included and compared according to whether the primary operator was an experienced, high-volume LM operator (defined as an operator who performed at least 15 LM PCIs per year for at least 3 consecutive years) or not. Kaplan-Meier estimates and Cox proportional hazards models are presented.
Results:
From January 2004 to December 2011, a total of 1,948 patients underwent unprotected LM PCI by 25 operators. Of these, 7 operators (28%) were considered experienced, and 18 (72%) were considered less experienced, with an overall mean experience of 12.0 ± 11.5 LM PCIs per year. LM PCI was performed in 1,422 patients (73%) by experienced operators and in 526 patients (27%) by less experienced operators. Patients treated by experienced operators had more complex and extensive coronary artery disease. Unadjusted and adjusted risks for cardiac death were lower for patients who were treated by experienced operators, both at 30-day (unadjusted hazard ratio [HR]: 0.23; 95% confidence interval [CI]: 0.09 to 0.60; p = 0.003; adjusted HR: 0.22; 95% CI: 0.09 to 0.59; p = 0.003) and 3-year (unadjusted HR: 0.53; 95% CI: 0.32 to 0.89, p = 0.02; adjusted HR: 0.49; 95% CI: 0.29 to 0.84; p = 0.009) follow-up. Discrimination improved when operator experience was added to Cox proportional hazards models containing the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (integrated discriminatory index = 0.004, p = 0.03) or SYNTAX score II (integrated discriminatory index = 0.007, p = 0.02). No significant interaction was detected between operator experience and distal bifurcation LM lesion, 2-stent bifurcation stenting, and intravascular ultrasound use (p > 0.10 for all).
Conclusions:
Patients who underwent LM PCI by high-volume and experienced operators had better short- and long-term prognoses. Operator experience is an important factor in a complex intervention such as LM PCI.
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