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Association of Annual Operator Volume With the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
Judit Karacsonyi, Ioannis Tsiafoutis, Khaldoon Alaswad
1Red Cross General Hospital, 1 Athanasaki St, 11526, Athens, Greece. koutouzismike@yahoo.gr.
Insights
High-volume operators (HVOs) performing chronic total occlusion percutaneous coronary intervention (CTO-PCI) achieve higher success rates but also experience more complications. Operator volume significantly impacts CTO-PCI outcomes, with HVOs demonstrating better technical success despite increased lesion complexity.
Area of Science:
- Interventional Cardiology
- Cardiovascular Interventions
- Vascular Medicine
Background:
- Limited data exist on the relationship between operator volume and outcomes for chronic total occlusion percutaneous coronary intervention (CTO-PCI).
- Understanding this association is crucial for optimizing patient care and procedural success in complex PCI cases.
Purpose of the Study:
- To analyze the association between operator volume and procedural outcomes in a large cohort of CTO-PCI procedures.
- To determine if higher operator volume correlates with improved technical success and complication rates in CTO-PCI.
Main Methods:
- A multicenter registry analysis of 7035 CTO-PCIs performed between 2012 and February 2021.
- Operators were categorized into low-volume (<30 cases/year), medium-volume (30-60 cases/year), and high-volume (>60 cases/year) groups.
- Outcomes including technical success and periprocedural major adverse cardiac events were compared across volume groups, adjusting for lesion complexity.
Main Results:
- High-volume operators (HVOs) performed procedures on more complex lesions, indicated by higher J-CTO scores and increased prevalence of proximal tortuosity and cap ambiguity.
- Cases performed by HVOs demonstrated higher technical success rates (87.9%) compared to medium-volume (86.9%) and low-volume operators (82.6%).
- HVOs also had higher rates of periprocedural major cardiac adverse events (3.08%) versus MVOs (2.71%) and LVOs (1.50%).
Conclusions:
- A significant proportion of CTO-PCI cases (40%) are performed by low-volume operators.
- While HVOs achieve superior technical success in CTO-PCI, this is associated with a higher incidence of periprocedural complications, likely due to managing more complex cases.
- Operator experience and case volume are critical factors influencing CTO-PCI outcomes, necessitating further investigation into strategies for improving results across all operator levels.
Objectives:
There are limited data on the association of operator volume with the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods:
We analyzed the association between operator volume and procedural outcomes of 7035 CTO-PCIs performed between 2012 and February 2021 at 30 centers.
Results:
The study population was divided into 3 groups based on annual operator CTO-PCI volume: low-volume operators (LVO: <30 cases/year; 39.7% of the cases); medium-volume operators (MVO: 30-60 cases/year; 25.7% of the cases); and high-volume operators (HVO: >60 cases/ year; 34.6% of the cases). Mean patient age was 64.4 ± 10 years and 82% were men. Cases performed by HVOs were more complex, with higher J-CTO score compared with cases performed by MVOs and LVOs (2.72 ± 1.27 vs 2.39 ± 1.19 vs 2.12 ± 1.27, respectively; P<.001). Moderate/severe proximal vessel tortuosity (35% vs 23% vs 20%; P<.001) and proximal cap ambiguity (44% vs 34% vs 32%; P<.001) was also more common in the HVO group. Cases performed by HVOs had higher technical success rates (87.9% vs 86.9% vs 82.6%; P<.001), but also higher rates of periprocedural major cardiac adverse events compared with MVOs and LVOs (3.08% vs 2.71% vs 1.50%; P<.01). On multivariable analyses, HVOs and MVOs were associated with higher technical success.
Conclusions:
In a contemporary, multicenter registry, 40% of CTO-PCI cases are performed by LVOs performing <30 cases per year. Cases performed by HVOs were associated with higher technical and procedural success, but also higher periprocedural major complication rates, potentially due to higher lesion complexity.
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