CathPCI Registry: How Does Operator Career Status Impact PCI Outcomes?

Early-career interventional cardiologists are performing PCI procedures on patients with more acute presentations and higher predicted risk of mortality and bleeding than their more experienced counterparts, which are associated with modestly worse outcomes, according to a study published May 13 in JACC.

Jennifer A. Rymer, MD, MBA, MHS, et al., used data from the ACC’s CathPCI Registry to conduct an operator-level analysis of patients undergoing PCI between April 2018 and June 2022. They examined annual case volume, expected mortality and bleeding risk, and observed/predicted mortality and bleeding outcomes, and included 1,451 early-career operators – within five years of the end of their training – and 6,251 non–early-career operators, with 1,011 operators changing their career status over the course of the study period. In total, 514,540 patients were treated by early-career operators and 2,296,576 patients by non–early-career operators.

Results showed that median annual case volume per operator was 59 (Q1-Q3: 31-97) for early-career operators vs. 57 (Q1-Q3: 28-100) for non–early-career operators. In addition, the authors found that early-career operators were more likely to perform PCI on patients presenting with STEMI and urgent indications for the procedure (both p<0.001).

When comparing early-career vs. non–early-career operators groups, median predicted mortality risk was 2.0% (Q1-Q3: 1.5%-2.7%) vs. 1.8% (Q1-Q3: 3.7%-5.3%) and median predicted bleeding risk was 4.9% (Q1-Q3: 4.2%-5.7%) vs. 4.4% (Q1-Q3: 3.7%-5.3%). Early-career operators were also associated with an increased risk of mortality (odds ratio [OR], 1.08; 95% CI, 1.05-1.17; p<0.0001) and bleeding (OR, 1.08; 95% CI, 1.05-1.12; p<0.0001) after adjustment.

“It would theoretically be beneficial for early-career operators to treat a lower-risk population while they develop their independent practice and hone skills, but our study found that the opposite occurs,” write the authors. “Early-career operators may be expected to carry a higher call burden during their early years in practice and are therefore performing a higher ratio of urgent/elective PCIs. It is also possible that early-career operators have more risk-tolerant case selection or are presented with high-risk cases by colleagues.”

In an accompanying editorial comment, Pinak B. Shah, MD, FACC; David A. Gross, MD, PhD; and Ajar Kochar, MD, MHS, FACC, add: “In an ideal world … there would be more direct on-the-job support and mentorship for [early-career interventional cardiologists] so that [they] can develop their practice and career that allows them to grow clinically and not necessarily expose them and their patients to worse outcomes.”

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: National Cardiovascular Data Registries, CathPCI Registry, Percutaneous Coronary Intervention, Cardiologists, Mentors, Registries

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