Association of Operator and Hospital Experience With Procedural Success Rates and Outcomes in Patients Undergoing Percutaneous Coronary Interventions for Chronic Total Occlusions
| Autor: | Rami Zein, Howard S. Rosman, Rajendra H. Mehta, Milan Seth, Daniel S. Menees, Khaldoon Alaswad, Hussein Othman, Thomas LaLonde, Edouard Daher, Hitinder S. Gurm |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Michigan medicine.medical_specialty Hospitals Low-Volume Time Factors Percutaneous medicine.medical_treatment Psychological intervention Workload 030204 cardiovascular system & hematology Risk Assessment Hospital experience 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Risk Factors Cardiovascular procedures Humans Medicine In patient Registries 030212 general & internal medicine Aged business.industry BLUE CROSS/BLUE SHIELD Percutaneous coronary intervention Middle Aged Blue Cross Blue Shield Insurance Plans Outcome and Process Assessment Health Care Treatment Outcome Coronary Occlusion Chronic Disease Emergency medicine Female Clinical Competence Cardiology and Cardiovascular Medicine business Hospitals High-Volume Learning Curve |
| Zdroj: | Circulation: Cardiovascular Interventions. 13 |
| ISSN: | 1941-7632 1941-7640 |
| DOI: | 10.1161/circinterventions.119.008863 |
| Popis: | Background: An inverse relationship has been described between procedural success and outcomes of all major cardiovascular procedures. However, this relationship has not been studied for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Methods: We analyzed the data on patients enrolled in Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry in Michigan (January 1, 2010 to March 31, 2018) to evaluate the association of operator and hospital experience with procedural success and outcomes of patients undergoing CTO-PCI. CTO-PCI was defined as intervention of a 100% occluded coronary artery presumed to be ≥3 months old. Results: Among 210 172 patients enrolled in the registry, 7389 (3.5%) CTO-PCIs were attempted with a success rate of 53%. CTO-PCI success increased with operator experience (45% and 65% in the lowest and highest experience tertiles) and was the highest for highly experienced operators at higher experience centers and the lowest for inexperienced operators at low experience hospitals. Multivariable logistic regression models (with spline transformed prior operator and institutional experience) demonstrated a positive relationship between prior operator and site experience and procedural success rates (likelihood ratio test=141.12, df=15, P P =0.208). Conclusions: Operator and hospital CTO-PCI experiences were directly related to procedural success but were not related to major adverse cardiac event among patients undergoing CTO-PCIs. Inexperienced operators at high experience centers had significantly higher success but not major adverse cardiac event rates compared with inexperienced operators at low experience centers. These data suggested that CTO-PCI safety and success could potentially be improved by selective referral of these procedures to experienced operators working at highly experienced centers. |
| Databáze: | OpenAIRE |
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