August 1, 2019Circulation Cardiovascular Interventions
Percutaneous Coronary Intervention for Chronic Total Occlusions
Key result
Increased operator experience in chronic total occlusion PCI was associated with greater case complexity, while new operators achieved a 61.4% procedural success rate.
Why the study?
Does incremental operator experience improve procedural success and outcomes in percutaneous coronary intervention for chronic total occlusions?
Population
93,875 percutaneous coronary intervention procedures for chronic total occlusions treated by 7,548 operators…
Comparison
Percutaneous coronary intervention for chronic… vs Less experienced operators
Design
Editorial
Follow-up
in-patient
Authors
Discussion
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Implication
There is a steep learning curve for CTO PCI, where increased operator experience parallels a willingness to tackle more complex cases, emphasizing the critical need for careful case selection and procedural awareness.
Structured PICO
Does incremental operator experience improve procedural success and outcomes in percutaneous coronary intervention for chronic total occlusions?
P
Population
93,875 percutaneous coronary intervention procedures for chronic total occlusions from a national registry to examine the operator learning curve.
E
Exposure
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) performed by operators gaining incremental experience
C
Comparator
Less experienced operators (analysis of the operator learning curve)
O
Outcome
In-patient mortality and major adverse cardiovascular event (death by myocardial infarction, tamponade, or PCI requiring urgent coronary artery bypass graft surgery)composite
There is a steep learning curve for CTO PCI, where increased operator experience parallels a willingness to tackle more complex cases, emphasizing the critical need for careful case selection and procedural awareness.
Limitations
- Availability of cooperators is not accounted for, which may confound the analysis.
- Unclear why 40% of cases were performed urgently or emergently despite CTO definition.
- Availability of cooperators is not accounted for, which may confound the analysis if a new operator worked with a very experienced second operator
- Unclear why approximately 40% of cases were performed urgently or emergently despite the standard definition of CTO
Cite This Study
Holmes et al. (2019) conducted an editorial in Chronic Total Occlusions (n=93,875). Operator experience in CTO PCI vs. Less experienced operators was evaluated on Procedural success and major adverse cardiovascular events. Increased operator experience in chronic total occlusion PCI was associated with greater case complexity, while new operators achieved a 61.4% procedural success rate.