Are Higher Operator Volumes for Unprotected Left Main Stem Percutaneous Coronary Intervention Associated With Improved Patient Outcomes?

Abstract

Background: The relationship between operator volume and survival after unprotected left main stem percutaneous coronary intervention (uLMS-PCI) is poorly defined. Methods: Data from the British Cardiovascular Intervention Society national PCI database were analyzed for all uLMS-PCI procedures performed in England and Wales between 2012 and 2014 and 4 quartiles of annualized uLMS-PCI volume (Q1–Q4) generated. Individual logistic regressions were performed for 12-month mortality to quantify the independent association between operator quartile and outcomes. Results: In total, 6724 uLMS-PCI procedures were analyzed with a negatively skewed distribution and an annualized median of 3 procedures per year. Operator volume ranged from 1 to 54 uLMS-PCI procedures/year. Within Q1, 347 operators performed a median of 2 procedures/year (interquartile range, 1–3); in Q2, 134 operators performed a median of 5 procedures/year (interquartile range, 4–6); in Q3, 59 operators performed a mean of 10 procedures/year (interquartile range, 8–12); and in Q4, 29 operators performed a mean of 21 procedures/year (interquartile range, 17–29). Higher volume operators undertook uLMS-PCI in patients with greater comorbid burden and performed more complex procedures compared with lower operator volumes. Adjusted in-hospital survival (odds ratio, 0.39 [95% CI, 0.24–0.67]; P <0.001), in-hospital major adverse cardiac and cerebral events (odds ratio, 0.41 [95% CI, 0.27–0.62]; P <0.001), and 12-month survival (odds ratio, 0.54 [95% CI, 0.39–0.73]; P <0.001) were lower in Q4 operators compared with Q1 operators. A close association between operator volume/case and superior 12-month survival was observed ( P <0.001). The lower volume threshold of minimum operator uLMS-PCI volume associated with improved survival was ≥16 cases/year. Conclusions: These data suggest that operator volume is an important factor in determining outcome after uLMS-PCI.

Volume-Outcome Relationship in Surgical and Cardiac Transcatheter Interventions with a Focus on Transcatheter Aortic Valve Implantation

“…Therefore, volume seems important in improving the outcome post rotational atherectomy. Other studies also showed a relationship between volume and outcome in complex procedures [17,18].…”

Clinical Characteristics and Outcomes Among Patients Undergoing High‐Risk Percutaneous Coronary Interventions by Single or Multiple Operators: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

“…39 , 40 Moreover, studies of operator volumes and long‐term outcomes in the United Kingdom have shown conflicting results for HR‐PCI overall as compared with a smaller subset of left main intervention procedures. 41 , 42 Physicians performing HR‐PCI in this study had an average of 9 years of experience after fellowship, and although interventionalists using a multioperator strategy worked at centers with higher annual HR‐PCI volumes, lead operators performed a similar number of HR‐PCI procedures per year compared with their single‐operator peers. These observations suggest that operators in this study may have developed a substantial body of experience with complex PCI, potentially negating the benefits of a second operator.…”

Radial versus femoral access for left main percutaneous coronary intervention: An analysis from the Veterans Affairs Clinical, Reporting, and Tracking Program

“…LM‐PCIs from sites with a predominant access site preference (> 90% or < 10% TRA LM‐PCI) were excluded to minimize any unmeasurable bias for a particular access site preference that could not be accounted for, and to allow comparison between groups where selection of access site was not driven by site‐wide preference. Similarly, low‐volume LM‐PCI sites (< 10 LM‐PCIs during the 10‐year study period) were excluded to minimize influence of an observed volume‐outcome relationship in LM‐PCI 15 . Patients with missing baseline clinical variables (body mass index [BMI] or international standardized ratio [INR] value) were also excluded.…”