Operator Experience and Outcomes After Left Main PCI
What is the impact of operator experience on outcomes of left main percutaneous coronary intervention (PCI)?
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.
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.
Patients treated by high-volume left main operators had better outcomes compared with those treated by low-volume operators.
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.
Keywords: Cardiac Surgical Procedures, Coronary Artery Disease, Myocardial Infarction, Percutaneous Coronary Intervention, Risk, Stents, Stroke, Thrombosis, Treatment Outcome
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