Effect of Operator Volume on In-Hospital Outcomes Following Primary Percutaneous Coronary Intervention for
Jung Hee Lee1, Sang Yong Eom2, Ung Kim1
1Division of Cardiovascular, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
Insights
Operator volume did not significantly impact in-hospital outcomes for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients. This study found no link between high-volume operators and improved survival or reduced complications after primary PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- The impact of operator experience on percutaneous coronary intervention (PCI) outcomes for ST-elevation myocardial infarction (STEMI) remains incompletely understood.
- Investigating the relationship between operator PCI volume and in-hospital results is crucial for optimizing STEMI care.
Purpose of the Study:
- To examine the association between operator PCI volume and in-hospital outcomes in STEMI patients.
- To determine if higher operator volume correlates with better results after primary PCI for STEMI.
Main Methods:
- Analysis of 8,282 STEMI patients undergoing primary PCI by 373 operators from the Korean nationwide K-PCI registry.
- Operators were categorized into high (>30 cases/year), moderate (10-30 cases/year), and low (<10 cases/year) volume groups.
- In-hospital outcomes including mortality, myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were assessed.
Main Results:
- No significant differences in in-hospital mortality, cardiac death, non-fatal MI, or stent thrombosis were observed across operator volume groups.
- A trend towards lower rates of urgent repeat PCI was noted in high-volume operators (0.6%) compared to moderate (0.7%) and low (1.5%) volume groups (p=0.095).
- Multivariate analysis confirmed that operator volume was not a predictor of adverse in-hospital outcomes.
Conclusions:
- In-hospital outcomes following primary PCI for STEMI were not associated with operator volume in this large Korean registry.
- These findings suggest that factors other than operator volume may be more critical for STEMI patient outcomes.
Background And Objectives:
The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI.
Methods:
Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10-30 cases/year), and below the 25th percentile (<10 cases/year) were defined as high, moderate, and low-volume operators, respectively. In-hospital outcomes including mortality, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were analyzed.
Results:
The average number of primary PCI cases performed by 373 operators was 22.2 in a year. In-hospital mortality after PCI for STEMI was 571 cases (6.9%). In-hospital outcomes by operator volume showed no significant differences in the death rate, cardiac death, non-fatal MI, and stent thrombosis. However, the rate of urgent repeat PCI tended to be lower in the high-volume operator (0.6%) than in the moderate-(0.7%)/low-(1.5%) volume operator groups (p=0.095). The adjusted odds ratios for adverse in-hospital outcomes were similar in the 3 groups. Multivariate analysis also showed that operator volume was not a predictor for adverse in-hospital outcomes.
Conclusions:
In-hospital outcomes after primary PCI for STEMI were not associated with operator volume in the K-PCI registry.
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