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Updated: Aug 15, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Operator volume and outcomes in 12,998 percutaneous coronary interventions. Northern New England Cardiovascular
P D McGrath1, D E Wennberg, D J Malenka
1Department of Medicine, Maine Medical Center, Portland 04102, USA.
Insights
Higher operator volume in percutaneous coronary interventions (PCIs) is linked to improved success rates and fewer complications. This study highlights the importance of operator experience for better patient outcomes in PCI procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- The 1993 ACC/AHA guidelines suggested cardiologists perform >75 PCIs/year for competency, but supporting data were limited.
- Operator volume as a predictor of percutaneous coronary intervention (PCI) outcomes requires further investigation.
Purpose of the Study:
- To investigate the relationship between the volume of percutaneous coronary interventions (PCIs) performed by an operator and patient outcomes.
- To provide data supporting or refuting existing recommendations on minimum operator volume for PCI procedures.
Main Methods:
- Retrospective analysis of 12,988 PCIs performed by 31 cardiologists across five hospitals between 1990-1993.
- Operators were stratified into terciles based on annual procedure volume.
- Univariate and multivariate regression analyses were employed to adjust for case-mix, assessing angiographic and clinical success, and in-hospital adverse events (CABG, MI, death).
Main Results:
- Higher operator volume correlated with increased angiographic success (84.7% to 90.3%) and clinical success (85.8% to 90.7%).
- Increased volume was associated with a significant reduction in referrals for coronary artery bypass graft surgery (CABG) (4.54% to 2.49%).
- While a trend towards higher myocardial infarction (MI) rates was observed in high-volume operators (2.00% to 2.57%), in-hospital mortality rates remained similar across all volume groups.
Conclusions:
- A significant association exists between higher operator volume and improved outcomes in percutaneous coronary interventions (PCIs).
- Further research is warranted to elucidate the factors contributing to the superior success rates and reduced adverse events observed among high-volume operators.
Objectives:
We sought to determine whether there is a relation between operator volume and outcomes for percutaneous coronary interventions (PCIs).
Background:
A 1993 American College of Cardiology/American Heart Association task force stated that cardiologists should perform > or = 75 procedures/year to maintain competency in PCIs; however, there were limited data available to support this statement.
Methods:
Data were collected from 1990 through 1993 on 12,988 PCIs (12,118 consecutive hospital admissions) performed by 31 cardiologists at two hospitals in New Hampshire and two in Maine and one hospital in Massachusetts supporting these procedures. Operators were categorized into terciles based on annualized volume of procedures. Univariate and multivariate regression analyses were used to control for case-mix. Successful outcomes included angiographic success (all lesions attempted dilated to < 50% residual stenosis) and clinical success (at least one lesion dilated to < 50% residual stenosis and no adverse outcomes). In-hospital adverse outcomes included coronary artery bypass graft surgery (CABG), myocardial infarction (MI) and death.
Results:
After adjustment for case-mix, higher angiographic (low, middle and high terciles: 84.7%, 86.1% and 90.3%, p-trend 0.006) and clinical success rates (85.8%, 88.0% and 90.7%, p-trend 0.025), with fewer referrals to CABG (4.54%, 3.75% and 2.49%, p-trend <0.001), were seen as operator volume increased. There was a trend toward higher MI rates for high volume operators (2.00%, 1.98% and 2.57%, p-trend 0.06); all terciles had similar in-hospital mortality rates (1.09%, 0.96% and 1.05%, p-trend 0.8).
Conclusions:
There is a significant relation between operator volume and outcomes in PCIs. Efforts should be directed toward understanding why high volume operators are more successful and encounter fewer adverse outcomes.
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