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Percutaneous transluminal coronary angioplasty by high-volume and low-volume operators
Insights
Low-volume percutaneous transluminal coronary angioplasty (PTCA) operators in experienced centers achieved lower success rates than high-volume operators. However, complication rates were similar, indicating PTCA can be performed safely by low-volume operators.
Area of Science:
- Interventional Cardiology
- Health Services Research
Background:
- Operator volume is a critical factor influencing procedural outcomes in interventional cardiology.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common revascularization technique, but its success can depend on operator experience.
Purpose of the Study:
- To compare the procedural success and complication rates of low-volume PTCA operators versus a high-volume operator.
- To evaluate the impact of experienced assistance on outcomes for low-volume operators.
Main Methods:
- Retrospective analysis of 396 consecutive PTCA procedures (excluding complex cases) performed by three low-volume operators and one high-volume operator.
- Data collected included procedural success rates and complication rates.
- Assisted procedures for low-volume operators involved the high-volume operator as a second operator.
Main Results:
- The high-volume operator had a success rate of 93% and a complication rate of 5%.
- Low-volume operators collectively achieved an 85% success rate, which was significantly lower than the high-volume operator (p<0.05).
- Complication rates were comparable between low-volume (6%) and high-volume (5%) operators, with no significant difference.
Conclusions:
- Low-volume operators in experienced centers can perform PTCA safely, even without direct assistance from a high-volume operator.
- While safety is maintained, the success rate for low-volume operators is demonstrably lower compared to high-volume counterparts.
Abstract:
We retrospectively compared the results of percutaneous transluminal coronary angioplasty (PTCA) of three low-volume operators (1.3 PTCAs/month) to those of a relatively high-volume operator (14.9 PTCAs/month) in 396 consecutive procedures (358 patients). PTCA for multiple vessels, total occlusions, or evolving acute myocardial infarction had been excluded. For low-volume operators experienced assistance was considered present when the high-volume operator participated as second operator. The three low-volume operators performed 42, 38, and 24 PTCAs, respectively. Success rates per procedure for these operators were 88%, 84%, and 83%, and the complications rates 5%, 3%, and 13%, respectively. The success rates for assisted vs. nonassisted procedures were 89% vs. 88%, 100% vs. 78%, and 90% vs. 71%, and the complications rates were 6% vs. 4%, and 0% vs. 21%, respectively. The high-volume operator performed 292 PTCAs, with a success rate of 93%, and a complication rate of 5%. The cumulated success rate of the three low-volume operators of 85% was significantly (p less than 0.05) lower than the 93% success rate of the high-volume operator, while the complication rates of 6% and 5%, respectively, were not significantly different. Low-volume operators in an experienced center can perform PTCA safely even without assistance by a high-volume operator. However, their success rate is lower.