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Retrospective Analysis of the Thai Percutaneous Coronary Intervention Registry: Impacts of Center Volume and Operator
Mann Chandavimol1, Thosaphol Limpijankit1, Suphot Srimahachota2
1Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Percutaneous coronary intervention (PCI) center volume did not significantly affect patient outcomes. However, operator experience, particularly years of practice, was linked to lower in-hospital mortality and fewer PCI failures, suggesting a focus on operator skill is crucial.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Percutaneous coronary intervention (PCI) outcomes are influenced by patient factors, lesion complexity, operator skill, and PCI center quality.
- Variability in PCI outcomes necessitates an understanding of contributing factors like center volume and operator experience.
Purpose of the Study:
- To evaluate the impact of Percutaneous coronary intervention (PCI) center volume and operator experience on patient outcomes.
- To identify key factors influencing success rates and complications in PCI procedures.
Main Methods:
- Retrospective analysis of 19,701 patients undergoing PCI in Thailand (2018-2019) across 39 hospitals.
- Categorization of PCI center volume (low, intermediate, high) and operator experience (years in practice, annual case volume).
- Assessment of outcomes including PCI failure, procedural complications, in-hospital mortality, and 1-year all-cause mortality.
Main Results:
- No significant difference in PCI failure, PCI-related in-hospital mortality, or 1-year all-cause mortality based on PCI center volume.
- Higher procedural complication rates observed in high-volume PCI centers compared to intermediate and low-volume centers.
- Operators with more years of practice showed lower PCI-related in-hospital mortality (OR 0.75).
- Operators performing more annual PCIs trended towards fewer PCI failures (OR 0.76).
Conclusions:
- PCI center volume did not significantly impact overall PCI outcomes.
- Operator experience, specifically years of practice and annual case volume, demonstrated a notable influence on specific patient outcomes.
- Findings suggest a need to refine national PCI strategies focusing on operator-level improvements.
Background:
Percutaneous coronary intervention (PCI) outcomes can vary due to various factors, including patient clinical condition, complexity of coronary lesions, expertise of operators, and quality of the PCI center.
Aims:
This study evaluated the influence of PCI center volume and operator experience on patient outcomes after the procedure.
Methods:
Retrospective data on demographic, clinical details, and outcomes for all patients undergoing PCI across 39 hospitals in Thailand from 2018 to 2019 were retrieved. PCI center volume was categorized based on annual number of interventions: low (< 200), intermediate (200-499), and high (≥ 500). Operator experience was assessed by years of practice (low [< 5] and high [≥ 5]) and the number of PCI cases performed annually (low [< 75] and high [≥ 75]). The evaluated PCI outcomes were: PCI failure; procedural complications; PCI-related in-hospital mortality; 1 year post-intervention all-cause mortality.
Results:
A total of 19,701 patients who underwent PCI were included in the analysis, of whom 17,432 had follow-up data available after 1 year. Of these, 58.1% presented with either ST-elevation or non-ST elevation myocardial infarction/unstable angina, while 41.9% had stable CAD. Nearly half of the patients had triple-vessel or left-main disease, and 8.7% presented with cardiogenic shock. The percent with PCI failure, procedural complications, PCI-related in-hospital death, and 1-year all-cause mortality were 4.9%, 5.1%, 2.7%, and 11.8%, respectively. Despite patients in higher-risk profiles being treated at high-volume PCI centers and by experienced operators, there were no significant differences in PCI failure, PCI-related in-hospital mortality nor 1-year all-cause mortality compared to those treated at low or intermediate volume PCI centers. However, high-volume PCI centers had procedural complications more frequently (4.7%) than did intermediate (3.9%) and low-volume (2.5%) centers (p < 0.001). After adjusting for confounding factors, no significant associations were found between PCI center volume and PCI outcome. Similarly, no significant relationship was found between operator experience and procedural complications, nor 1-year all-cause mortality. Nevertheless, operators with more years of practice were associated with lower PCI-related in-hospital mortality (odds ratio [95% CI] of 0.75 (0.57, 0.98); p < 0.038). Additionally, operators conducting a higher number of PCIs annually tended to have less PCI failures (odds ratio [95% CI] of 0.76 (0.57, 1.01); p = 0.062).
Conclusion:
A center's PCI volume did not significantly impact PCI outcome. In contrast, operator experience did impact outcomes. This result highlights areas for improvement and can help reform strategies for national PCI systems at both center and operator levels.
