Operator Experience and Outcomes After Left Main PCI

Study Questions:

What is the impact of operator experience on outcomes of left main percutaneous coronary intervention (PCI)?

Methods:

The authors analyzed outcomes of consecutive patients who underwent unprotected left main PCI at a high-volume institution in China. Operators were classified as experienced if they performed at least 15 left main PCIs per year for at least 3 consecutive years.

Results:

Over an 8-year period, a total of 1,948 patients underwent unprotected left main PCI by 25 operators. Of these, seven operators were considered experienced and they performed the majority of the procedures (1,422, 72%). The annual left main PCI volume ranged from 1-41 (average 12). Patients treated by experienced operators had more complex and extensive coronary artery disease. Patients treated by high-volume operators had lower 30-day all-cause mortality (0.6 vs. 2.1%, p = 0.008). Rates of myocardial infarction, stent thrombosis, and stroke were also nominally lower among patients treated by experienced operators. Patients who were treated by high-volume operators had a significantly lower risk for cardiac death (2.5% vs. 4.6%, p = 0.02), with a trend toward lower all-cause mortality (3.8% vs. 5.3%, p = 0.15) at 3 years.

Conclusions:

Patients treated by high-volume left main operators had better outcomes compared with those treated by low-volume operators.

Perspective:

Left main PCI is a viable option for many patients and an increasing body of data suggests that it may be preferable to surgery in a large subgroup of patients (Cavalcante R, et al. J Am Coll Cardiol 20166;68:999-1009). This study highlights the importance of operator experience on outcome of patients undergoing left main PCI and suggests that PCI by a high-volume operator is associated with a better short- and long-term outcome.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Interventions and Coronary Artery Disease

Keywords: Cardiac Surgical Procedures, Coronary Artery Disease, Myocardial Infarction, Percutaneous Coronary Intervention, Risk, Stents, Stroke, Thrombosis, Treatment Outcome


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