title: Comparison of procedural complications with versus without interventional cardiology fellows-in-training during contemporary percutaneous coronary intervention.
abstract: Despite increasing complexity of contemporary procedures at tertiary care hospitals, the relationship between interventional cardiology fellows-in-training (ICFITs) and complications of percutaneous coronary intervention (PCI) has not been reported. We compiled logbooks of 6 ICFITs at an academic hospital and evaluated patient and procedural characteristics of PCIs performed with and without presence of an ICFIT. The primary end point was the composite of all in-hospital PCI complications defined by the American College of Cardiology's National Cardiovascular Data Registry: (1) catheterization laboratory events such as no-reflow and dissection/perforation, (2) general clinical events such as stroke or cardiogenic shock, (3) vascular and bleeding complications, and (4) miscellaneous complications such as peak troponin or creatinine levels. Logistic regression adjusted for differences in measured confounders between patients treated with and without presence of an ICFIT. All analyses were repeated after excluding PCI for ST-elevation myocardial infarction. Of 2,605 PCI procedures at the academic hospital between July 2007 and April 2010, an ICFIT was present for 1,638 procedures (63%). Despite having worse clinical and procedural characteristics, patients in the ICFIT group experienced similar rates of the composite end point (12.9% vs 14.5% without ICFIT, p = 0.27). Longer mean fluoroscopy times and greater number of stents were noted in the ICFIT group; however, hospital length of stay was shorter and no individual adverse events were increased in the ICFIT procedures. Presence of an ICFIT remained unrelated to the composite end point after multivariable adjustment (odds ratio 0.92, 95% confidence interval 0.71 to 1.20; p = 0.53), and findings were similar after excluding PCI for ST-elevation myocardial infarction. In conclusion, in contemporary practice at a large academic medical center, PCI complication rates were not adversely affected by the presence of an ICFIT.
authors.affiliation: Saint Louis University, St. Louis, Missouri. Electronic address: jstolker@yahoo.com.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Stolker
authors.affiliation: Hutchinson Clinic, Hutchinson, Kansas.
authors.forename: Drew S
authors.initials: DS
authors.lastname: Allen
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Laster
authors.affiliation: Eisenhower Desert Cardiology Consultants, Rancho Mirage, California.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Frutkin
authors.affiliation: Colorado Heart and Vascular, Denver, Colorado.
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Mehta
authors.affiliation: Intermountain Heart Institute, Salt Lake City, Utah.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: O'Neal
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
mesh_terms: D000368:Aged; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies