Percutaneous transluminal coronary angioplasty by high-volume and low-volume operators.
We retrospectively compared the results of percutaneous transluminal coronary angioplasty (PTCA) of three low-volume operators (1.3 PTCAs/month) to those of a relatively high-volume operator (14.9 PTCAs/month) in 396 consecutive procedures (358 patients). PTCA for multiple vessels, total occlusions, or evolving acute myocardial infarction had been excluded. For low-volume operators experienced assistance was considered present when the high-volume operator participated as second operator. The three low-volume operators performed 42, 38, and 24 PTCAs, respectively. Success rates per procedure for these operators were 88%, 84%, and 83%, and the complications rates 5%, 3%, and 13%, respectively. The success rates for assisted vs. nonassisted procedures were 89% vs. 88%, 100% vs. 78%, and 90% vs. 71%, and the complications rates were 6% vs. 4%, and 0% vs. 21%, respectively. The high-volume operator performed 292 PTCAs, with a success rate of 93%, and a complication rate of 5%. The cumulated success rate of the three low-volume operators of 85% was significantly (p less than 0.05) lower than the 93% success rate of the high-volume operator, while the complication rates of 6% and 5%, respectively, were not significantly different. Low-volume operators in an experienced center can perform PTCA safely even without assistance by a high-volume operator. However, their success rate is lower.
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000592:standards*; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies