title: Clinical outcomes after myocardial revascularization according to operator training status: cohort study of 22,697 patients undergoing percutaneous coronary intervention or coronary artery bypass graft surgery.
abstract: OBJECTIVE
  Myocardial revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) carries the risk of serious complications. Observational data suggest that outcomes may be improved by experienced operators, but there are few studies that have analysed the relationship between mortality and primary operator grade. The aim of this study was to investigate the effect of operator grade (trainee vs. consultant) upon outcomes of revascularization procedures.
  
  
  RESULTS
  This was an observational study at a tertiary cardiology centre with accredited training programmes, between 2003 and 2011. A total of 22 697 consecutive patients undergoing either CABG or PCI were included. Associations between operator grade and mortality were assessed by hazard ratios, estimated by Cox regression analyses; 6689 patients underwent CABG, whereas 16 008 underwent PCI. Trainees performed 1968 (29.4%) CABG procedures and 8502 (53.1%) PCI procedures. The proportion of procedures performed by trainees declined over time for both CABG (30.2% in 2003 vs. 26.0% in 2010) and for PCI (58.1% in 2003 vs. 44.5% in 2010). In the unadjusted Cox analysis, consultant operator grade was associated with an increased 5-year mortality after both CABG [HR: 1.26 (95% CI: 1.07-1.47)] and PCI procedures [HR: 1.34 (95% CI: 1.22-1.47)] compared with a trainee operator. However, following multiple adjustment, consultant grade was no longer associated with mortality after either procedure [CABG: HR: 1.02 (95% CI: 0.87-1.20), PCI: HR: 1.08 (95% CI: 0.98-1.20)].
  
  
  CONCLUSIONS
  There was no observed detrimental effect on patient outcomes arising from procedures undertaken by trainees working in a structured training environment compared with consultants.
authors.affiliation: Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, Bonner Road,  London E2 9JX UK.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.forename: Sean
authors.initials: S
authors.lastname: Gallagher
authors.forename: Krishnaraj
authors.initials: K
authors.lastname: Rathod
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Jain
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.forename: Rakesh
authors.initials: R
authors.lastname: Uppal
authors.forename: Mark
authors.initials: M
authors.lastname: Westwood
authors.forename: Kit
authors.initials: K
authors.lastname: Wong
authors.forename: Martin T
authors.initials: MT
authors.lastname: Rothman
authors.forename: Alex
authors.initials: A
authors.lastname: Shipolini
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Smith
authors.forename: Peter G
authors.initials: PG
authors.lastname: Mills
authors.forename: Adam D
authors.initials: AD
authors.lastname: Timmis
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Knight
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Archbold
authors.forename: Andrew
authors.initials: A
authors.lastname: Wragg
mesh_terms: D002309:Cardiology / Q000592:standards* / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards*; D003253:Consultants / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000601:surgery*; D004638:Emergency Treatment / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007318:Inservice Training; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D009204:Myocardial Revascularization / Q000401:mortality* / Q000592:standards / Q000706:statistics & numerical data; D061646:Operative Time; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000592:standards / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000401:mortality; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D020521:Stroke / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
keywords: CABG; PCI; Training