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Operator Volumes and Outcomes After ROTA-PCI
Quick Takes
- Despite higher volume ROTA-PCI operators undertaking more complex procedures in higher risk patients, in-hospital outcomes including MACCE and major bleeding occurred less frequently with higher operator volume.
- These data imply that operator volume is an important factor determining outcome after ROTA-PCI.
- PCI centers without sufficient ROTA-PCI volume may consider a network/regional strategy with case referral between hospitals in an effort to improve patient outcomes.
Study Questions:
What is the relationship between operator percutaneous coronary intervention (PCI) using rotational atherectomy (ROTA-PCI) volumes and in-hospital patient outcomes?
Methods:
The investigators analyzed data from the British Cardiovascular Intervention Society (BCIS) national PCI database for all ROTA-PCI procedures performed in the United Kingdom between 2013 and 2016. Individual logistic regressions were performed to quantify the independent association between annual operator ROTA-PCI volume and in-hospital outcomes.
Results:
A total of 7,740 ROTA-PCI procedures were performed with a negatively skewed distribution and an annualized operator volume median of 2.5 procedures/year (range 0.25-55.25). Higher volume operators undertook more complex procedures in patients with a greater comorbid burden than lower volume operators. A significant inverse association was observed between operator ROTA-PCI volume and in-hospital mortality (odds ratio [OR], 0.986/case; 95% confidence interval [CI], 0.975-0.996; p = 0.007) and major adverse cardiac and cerebral events (MACCE) (OR, 0.983/case; 95% CI, 0.975-0.993; p < 0.001).
Additionally, lower rates of emergency cardiac surgery (OR, 0.964/case; 95% CI, 0.939-0.991; p = 0.008), arterial complications (OR, 0.975/case; 95% CI, 0.975-0.982; p < 0.001), and in-hospital major bleeding (OR, 0.985/case; 95% CI, 0.977-0.993; p < 0.001) were associated with higher ROTA-PCI operator volume. Sensitivity analyses in several subgroups demonstrated a consistency of improved outcomes as annual ROTA-PCI volume increased. An annual volume of below four ROTA-PCI procedures/year was observed to be associated with increased MACCE, with 239/432 (55%) operators not exceeding this threshold.
Conclusions:
The authors concluded that in-hospital adverse outcomes occurred less frequently as ROTA-PCI operator volume increased.
Perspective:
This observational study reports that despite higher volume ROTA-PCI operators undertaking more complex procedures in higher risk patients, in-hospital outcomes including MACCE and major bleeding occurred less frequently with higher operator volume. These data imply that operator volume is an important factor determining outcome after ROTA-PCI. PCI centers without sufficient ROTA-PCI volume may consider a network/regional strategy with case referral between hospitals in an effort to improve patient outcomes. This and other data suggest that practicing with a heavily negatively skewed distribution of low operator ROTA-PCI volume could represent suboptimal patient care and adverse clinical outcomes.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias
Keywords: Atherectomy, Coronary, Cardiovascular Surgical Procedures, Hemorrhage, Hospital Mortality, Hospitals, High-Volume, Myocardial Ischemia, Outcome Assessment, Health Care, Patient Outcome Assessment, Percutaneous Coronary Intervention, Risk, Secondary Prevention
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