Operator experience and long term outcome after percutaneous coronary intervention.
OBJECTIVE
To investigate the impact of operator experience on long term outcome of patients undergoing percutaneous coronary intervention (PCI).


METHODS
Two hundred and fifty consecutive patients with 334 lesions undergoing elective PCI by three highly experienced (greater than 600 PCI, mean 1100) and three less experienced (fewer than 400 PCI, mean 250) high volume operators at a single tertiary care centre were prospectively studied. Quantitative assessment of the six-month angiography was possible in 273 lesions (82%). Clinical follow-up at 24 months was complete in all patients.


RESULTS
Baseline characteristics of the 159 lesions treated by the highly experienced operators were comparable with the 175 lesions treated by the less experienced operators. Six months following PCI, the minimal lumen diameter at the lesion site was similar for both more experienced and less experienced operators (1.68+/-0.95 mm versus 1.63+/-0.89 mm, P=0.66), as was net lumen gain (0.97+/-1.02 mm versus 0.98+/-0.93 mm, P=0.96) and the rate of restenosis (33% versus 32%, P=0.87). By multivariate analysis, lower operator experience was not a predictor of restenosis (odds ratio 0.97, 95% CI 0.75 to 1.25, P=0.81). In addition, 24-month clinical follow-up did not reveal any relevant difference in the combined end point of death, myocardial infarction or clinically driven revascularization between more experienced (29 events in 116 patients) and less experienced operators (35 events in 134 patients; 25% versus 26%, P=0.84).


CONCLUSIONS
Less experienced high volume operators seem to achieve similar long term results as more experienced high volume operators.
Mueller
Christian
C
Medizinische Universitätsklinik Basel, Basel, Switzerland. chmueller@uhbs.ch
Hodgson
John McB
JM
Brutsche
Martin
M
Bestehorn
Hans-Peter
HP
Marsch
Stephan
S
Perruchoud
André P
AP
Roskamm
Helmut
H
Buettner
Heinz J
HJ
D015906:Angioplasty, Balloon, Coronary / Q000193:education; D002983:Clinical Competence; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D019233:Retreatment; D018570:Risk Assessment; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome