Key result
Low (<50 cases/year) and intermediate (50-74 cases/year) PCI operator volumes were not significantly associated with major complications compared to high volume operators (0.45% and 1.1% vs 0.86%).
Why the study?
Does low or intermediate operator volume increase major complications in patients undergoing percutaneous coronary intervention compared to high operator volume?
Observational (n=6,510)
Yes
Does low or intermediate operator volume increase major complications in patients undergoing percutaneous coronary intervention compared to high operator volume?
Operator PCI volume (<75 cases/year) was not significantly associated with increased major complications compared to high volume in the era of coronary stenting.
No support for volume-based PCI restrictions; leaves open confirmation in prospective contemporary cohorts.
The 2001 ACC/AHA guidelines recommend that percutaneous coronary intervention (PCI) operators perform at least 75 procedures per year to maintain their competency. We performed a post hoc analysis of prospectively gathered PCI data, in the current era of ubiquitous stent use, at two tertiary cardiac care centres. Operators were assigned to a low (<50 cases per year), intermediate (50-74 cases per year) or high volume (>or=75 cases per year) group. Complications evaluated were death, myocardial infarction, coronary perforation, emergent coronary artery bypass surgery and pericardial tamponade. Between 2000 and 2002, 51 operators performed 6,510 PCIs. Stents were used in 79% of cases. Major complications occurred in 0.45% (7/1,572 cases) for the low-volume group, 1.1% in the intermediate-volume group (16/1,438 cases) and 0.86% (30/3,500 cases) for the high-volume group. After adjusting for baseline factors, low- and intermediate-volume operators were not significantly associated with major complications. This study questions the relationship between operator volume and PCI complications in the current era.
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Mustafa et al. (2005) conducted an observational in Percutaneous coronary intervention (n=6,510). Low (<50 cases/year) and intermediate (50-74 cases/year) volume PCI operators vs. High volume (≥75 cases/year) PCI operators was evaluated on Major complications (death, myocardial infarction, coronary perforation, emergent coronary artery bypass surgery and pericardial tamponade). Low (<50 cases/year) and intermediate (50-74 cases/year) PCI operator volumes were not significantly associated with major complications compared to high volume operators (0.45% and 1.1% vs 0.86%).
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