Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators?

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Education

Background:

• Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is typically reserved for experienced consultants.
• Trainees (fellows-in-training or FIT) are often limited in performing CHIP-PCI as primary operators due to the procedure's inherent risks.

Purpose of the Study:

• To investigate whether outcomes of CHIP-PCI differ when performed by a supervised FIT versus a consultant as the primary operator.
• To assess the safety and feasibility of training FIT in CHIP-PCI procedures.

Main Methods:

• Analysis of 2295 CHIP-PCI cases (UK-BCIS CHIP Score ≥3) from three UK cardiac centers (2018-2022).
• Comparison of in-hospital major adverse cardiac events (IH-MACCE) between supervised FIT and consultant primary operators.
• Multivariate logistic regression models were used to adjust for baseline and procedural characteristics.

Main Results:

• Supervised FIT performed 36% of CHIP-PCI cases, often with lower baseline complexity.
• Multivariate analysis showed no significant difference in IH-MACCE (OR 0.72, 95% CI: 0.34 to 1.51) between supervised FIT and consultant operators.
• Sensitivity analyses for higher CHIP Scores (4+ and 5+) also demonstrated comparable IH-MACCE.

Conclusions:

• Training FIT as primary operators in CHIP-PCI is feasible and safe within standard programs.
• Comparable outcomes suggest the benefit of the 'buddy' effect in supervised procedures.
• This approach supports the integration of CHIP-PCI training into cardiology fellowship programs.