Operator volume is not associated with mortality following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society registry

Aims: The relationship between operator volume and outcomes for percutaneous coronary intervention (PCI) has been studied in the past, but recent analyses of national data covering the modern radial, acute coronary syndrome-dominant era are limited. Changing in case-mix, practice, and service provision mean that previously described volume-outcome relationships may no longer be relevant, and a reassessment in contemporary practice is needed. We aim to assess whether operator volume is associated with independently reported 30-day mortality in a contemporary PCI cohort. Methods and results: This observational cohort study analysed procedures recorded in the British Cardiovascular Intervention Society PCI database from 2013 to 2014 in England and Wales. Mixed effects multiple logistic regression modelling was used to account for operator and centre level effects and to adjust for potential confounders. Volume is defined as the total number of procedures the operator was responsible for in the previous 12 months. A total of 133 970 procedures were analysed. Median volume across all procedures was 178 per year (interquartile range 128-239). The 30-day mortality rate was 2.6%. After adjustment for case-mix, the association between volume and mortality was negligible (odds ratio per 100 procedures 0.99, 95% confidence interval 0.93-1.05; P = 0.725). Sensitivity analyses showed similar results amongst high-risk PCI subsets and in-hospital outcomes. Conclusion: There is no evidence that mortality differs by operator volume in the UK. Volume-outcome relationships in PCI should be carefully monitored in response to future changes in practice.