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Updated: Oct 9, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Percutaneous Coronary Intervention Following Diagnostic Angiography by Noninterventional Versus Interventional
Fabio V Lima1, Pratik Manandhar2, Daniel Wojdyla2
1Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (F.V.L., H.D.A., V.K., J.D.A.).
Insights
Diagnostic cardiac catheterization with percutaneous coronary intervention (PCI) by invasive-diagnostic and interventional (Dx/IC) teams versus solo interventional operators (solo-IC) showed similar major adverse cardiovascular event risks. Rarely appropriate PCI occurred more often with Dx/IC teams, warranting further study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Limited contemporary national data exist on diagnostic cardiac catheterization with percutaneous coronary intervention (PCI) performed by invasive-diagnostic and interventional (Dx/IC) teams versus solo interventional operators (solo-IC).
- The CathPCI Registry provides a valuable resource for analyzing trends and outcomes in ad hoc PCI procedures.
Purpose of the Study:
- To analyze trends and outcomes of ad hoc PCI performed by Dx/IC teams compared to solo-IC operators.
- To assess the association between operator type and in-hospital major adverse cardiovascular events (MACE), net adverse cardiovascular events (NACE), and rarely appropriate PCI.
Main Methods:
- Utilized data from the CathPCI Registry, including quarterly rates of ad hoc PCI from January 2012 to March 2018.
- Employed multivariable regression to estimate odds of in-hospital MACE, NACE (composite of MACE + bleeding), and rarely appropriate PCI.
- Included 1,262,948 patients from 1077 sites, analyzing trends in operator types and patient characteristics.
Main Results:
- The proportion of Dx/IC teams performing ad hoc PCI decreased from 9% to 5% during the study period.
- Adjusted analyses revealed similar risks of MACE (OR, 1.04) and NACE (OR, 0.98) for Dx/IC versus solo-IC operators.
- Rarely appropriate PCI occurred more frequently in the Dx/IC group (2.1% vs 1.9%; OR, 1.20) compared to solo-IC operators.
Conclusions:
- Contemporary data show a decrease in Dx/IC teams performing ad hoc PCI, but stable case volumes among operators.
- Ad hoc PCI outcomes were independent of operator type, supporting current practice patterns.
- The higher risk of rarely appropriate PCI with Dx/IC teams requires further investigation.
Background:
There are limited contemporary, national data describing diagnostic cardiac catheterization with subsequent percutaneous coronary intervention (ad hoc percutaneous coronary intervention [PCI]) performed by an invasive-diagnostic and interventional (Dx/IC) operator team versus solo interventional operator (solo-IC). Using the CathPCI Registry, this study aimed at analyzing trends and outcomes in ad hoc PCI among Dx/IC versus solo-IC operators.
Methods:
Quarterly rates (January 2012 to March 2018) of ad hoc PCI cases by Dx/IC and solo-IC operators were obtained. Odds of inhospital major adverse cardiovascular events, net adverse cardiovascular events (ie, composite major adverse cardiovascular event+bleeding), and rarely appropriate PCI were estimated using multivariable regression.
Results:
From 1077 sites, 1 262 948 patients were included. The number of invasive-diagnostic operators and cases performed by Dx/IC teams decreased from nearly 9% to 5% during the study period. Patients treated by Dx/IC teams were more often White and had fewer comorbidities compared with patients treated by solo-IC operators. Considerable variation existed across sites, and over two-fifths of sites had 0% ad hoc PCI performed by Dx/IC. In adjusted analyses, ad hoc performed by Dx/IC had similar risks of major adverse cardiovascular event (OR, 1.04 [95% CI, 0.97-1.11]) and net adverse cardiovascular events (OR, 0.98 [95% CI, 0.94-1.03]) compared with solo-IC. Rarely appropriate PCI, although low overall (2.1% versus 1.9%) occurred more often by Dx/IC compared with solo-IC (OR, 1.20 [95% CI, 1.13-1.26]).
Conclusions:
Contemporary, nationwide data from the CathPCI Registry demonstrates the number of Dx/IC operator teams and cases has decreased but that case volume is stable among operators. Outcomes were independent of operator type, which supports current practice patterns. The finding of a higher risk of rarely appropriate PCI in Dx/IC teams should be further studied.
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