Learning curve for percutaneous transluminal coronary angioplasty: skill, technology or patient selection

As with all sophisticated techniques, operators who perform PTCA show a learning curve. It can best be visualized by observing changes in success rate with growing numbers of patients. Thus, the current success rate and complication rate of a particular operator may permit an estimate of the accumulated number of patients treated by that operator. Most likely, the learning curve is also reflected in the rate of long-term success, although it may be obscured by other factors in the variable natural course of CAD. The initial steep upslope of the learning curve is mainly caused by the growing skill of the particular operator. The later, flatter part appears to be secondary to improvements in technical equipment, which take more time. Patient selection has 2 effects on the learning curve that may be self-compensating. If lessons from the past are used for selection and conservatism is preserved, the learning curve will become more pronounced.