Operator volume is not associated with mortality following percutaneous coronary intervention: insights from the...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• The relationship between operator volume and outcomes for percutaneous coronary intervention (PCI) is debated.
• Previous studies may not reflect current practices in the radial, acute coronary syndrome-dominant era.
• Contemporary data on volume-outcome relationships in PCI are limited.

Purpose of the Study:

• To assess the association between operator volume and 30-day mortality in a contemporary PCI cohort in England and Wales.
• To re-evaluate the relevance of historical volume-outcome relationships in modern interventional cardiology.
• To determine if operator experience influences patient outcomes after PCI.

Main Methods:

• Observational cohort study using the British Cardiovascular Intervention Society PCI database (2013-2014).
• Analysis of 133,970 PCI procedures, with operator volume defined as procedures in the preceding 12 months.
• Mixed effects multiple logistic regression used to adjust for confounders and account for operator/center effects.

Main Results:

• The overall 30-day mortality rate was 2.6%.
• After adjusting for case-mix, operator volume showed a negligible association with 30-day mortality (OR per 100 procedures = 0.99, P=0.725).
• Sensitivity analyses confirmed these findings in high-risk PCI subsets and for in-hospital outcomes.

Conclusions:

• No evidence suggests that 30-day mortality in the UK differs based on operator volume for PCI.
• Volume-outcome relationships in PCI warrant continued monitoring due to potential future practice changes.
• Contemporary PCI practice in the UK does not demonstrate a significant link between operator volume and patient mortality.