Long-term outcomes and operators' experience in primary percutaneous coronary intervention for ST-segment elevation
Kei Takamizawa1, Masaomi Gohbara2, Yohei Hanajima1
1Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Insights
Primary percutaneous coronary intervention for ST-elevation myocardial infarction by less experienced operators is safe when supported by experts. Long-term outcomes show no increased risk of cardiovascular events or mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Primary percutaneous coronary intervention (pPCI) is the standard treatment for ST-elevation myocardial infarction (STEMI).
- Typically, pPCI procedures are performed by highly experienced interventional cardiologists.
- The safety and efficacy of pPCI for STEMI performed by less experienced operators, with expert support, require further investigation.
Purpose of the Study:
- To evaluate the long-term safety and outcomes of pPCI for STEMI performed by less experienced operators under the supervision of experienced operators.
- To compare cardiovascular event rates between STEMI patients treated by less experienced and experienced operators.
Main Methods:
- A total of 775 STEMI patients were analyzed, categorized into less experienced (n=384) and experienced (n=391) operator groups.
- Less experienced operators performed pPCI with direct support from experienced operators.
- Propensity score-matching was used to create comparable groups for analysis, focusing on the primary endpoint of major adverse cardiovascular events over a median of 5 years.
Main Results:
- In the propensity score-matched analysis (324 patients per group), the cumulative incidence of the primary endpoint (cardiovascular death, nonfatal myocardial infarction, heart failure hospitalization) was similar between groups (15% vs. 18%, P=0.209).
- Multivariate analysis revealed no increased risk for the primary endpoint in patients treated by less experienced operators (adjusted hazard ratio, 0.85; 95% CI, 0.58-1.25; P=0.417).
- No significant difference in in-hospital mortality or 5-year cardiovascular events was observed.
Conclusions:
- Primary percutaneous coronary intervention for STEMI performed by less experienced operators, with experienced operator support, is associated with similar long-term cardiovascular outcomes compared to procedures performed by experienced operators alone.
- This approach does not increase the risk of in-hospital mortality or major adverse cardiovascular events at 5 years.
- Supervised pPCI by less experienced operators represents a safe and feasible strategy for STEMI management.
Abstract:
Primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) is typically performed by experienced operators. Therefore, the safety of pPCI for STEMI performed by less experienced operators with the support of experienced operators remains unknown. We aimed to investigate the long-term outcomes of pPCI for STEMI performed by less experienced operators with the support of experienced operators. In total, 775 STEMI patients were enrolled and divided into groups according to operator experience in PCI: less experienced (n = 384) and experienced (n = 391) operator groups. Experienced operators were defined as those who had performed > 50 elective PCI procedures per year as the first operator or instructional assistant, whereas less experienced operators were defined as others. When less experienced operators performed the pPCI, experienced operators supported them. The primary endpoint was any cardiovascular event, defined as a composite of cardiovascular death, nonfatal myocardial infarction, and unplanned hospitalization for heart failure. In the propensity score-matched analysis, 324 patients were included in each group. The cumulative incidence of the primary endpoint over a median of 5 years in the less experienced operator group was similar to that in the experienced operator group (15% vs. 18%, P = 0.209). In the multivariate Cox proportional hazards model, there was no excess risk for patients operated upon by less experienced operators for the primary endpoint (adjusted hazard ratio, 0.85; 95% confidence interval, 0.58-1.25; P = 0.417). pPCI for STEMI by less experienced operators did not increase the risk of in-hospital mortality or 5-year long-term cardiovascular events if supported by experienced operators.
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