title: Operator dependence of outcome after primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Primary percutaneous coronary intervention (PCI) is a widely practised therapeutic procedure to treat ST-elevation myocardial infarction (STEMI). However, a significant proportion of patients undergoing primary PCI suffers from adverse events, such as incomplete myocardial reperfusion. It is currently unknown to which degree these adverse events are operator related.
  
  
  RESULTS
  We investigated inter-operator variation using objective safety and efficacy endpoints during primary PCI for STEMI. All PCIs were performed by six experienced interventional cardiologists as part of a randomised single centre trial. The primary endpoint of this study was optimal myocardial reperfusion (myocardial blush grade 3 [MBG]). All 1,071 patients enrolled in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) were included in this analysis. In the six operator groups, the rate of the primary endpoint MBG 3 ranged between 29.2% and 55.5%. The variable for operators remained significantly associated with MBG 3 after adjustment for baseline and procedural differences. There were no statistical differences observed with regard to safety endpoints.
  
  
  CONCLUSIONS
  This study illustrates the observation that even in a controlled setting significant inter-operator variation may exist in the efficacy of primary PCI. This study supports the routine collection of high-quality datasets to evaluate and improve individual operator competence and skills.
authors.affiliation: University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. p.j.j.vlaar@thorax.uncg.nl
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Vlaar
authors.forename: Bart J
authors.initials: BJ
authors.lastname: de Smet
authors.forename: Ad F
authors.initials: AF
authors.lastname: van den Heuvel
authors.forename: Rutger L
authors.initials: RL
authors.lastname: Anthonio
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Jessurun
authors.forename: Eng-Shiong
authors.initials: ES
authors.lastname: Tan
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D002983:Clinical Competence; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging; D009426:Netherlands; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome