title: Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions.
abstract: To assess the impact of proctoring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in six UK centres.
  
  
  
  We retrospectively analysed 587 CTO procedures from six UK centres and compared success rates of operators who had received proctorship with success rates of the same operators before proctorship (pre-proctored) and operators in the same institutions who had not been proctored (non-proctored). There were 232 patients in the pre-proctored/non-proctored group and 355 patients in the post-proctored group. Complexity was assessed by calculating the Japanese CTO (JCTO) score for each case.
  
  
  
  CTO PCI success was greater in the post-proctored compared with the pre-proctored/non-proctored group (77.5% vs 62.1%, p<0.0001). In more complex cases where JCTO≥2, the difference in success was greater (70.7% vs 49.5%, p=0.0003). After proctoring, there was an increase in CTO PCI activity in centres from 2.5% to 3.5%, p<0.0001 (as a proportion of total PCI), and the proportion of very difficult cases with JCTO score ≥3 increased from 15.3% (35/229) to 29.7% (105/354), p<0.0001.
  
  
  
  Proctoring resulted in an increase in procedural success for CTO PCI, an increase in complex CTO PCI and an increase in total CTO PCI activity. Proctoring may be a valuable way to improve access to CTO PCI and the likelihood of procedural success.
authors: Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK.
authors: Vinoda
authors: V
authors: Sharma
authors: Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK.
authors: S T
authors: ST
authors: Jadhav
authors: Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK.
authors: A A
authors: AA
authors: Harcombe
authors: The Essex Cardiothoracic Centre , Essex , UK.
authors: P A
authors: PA
authors: Kelly
authors: The Essex Cardiothoracic Centre , Essex , UK.
authors: A
authors: A
authors: Mozid
authors: Freeman Hospital , Newcastle upon Tyne , UK.
authors: A
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authors: Bagnall
authors: Freeman Hospital , Newcastle upon Tyne , UK.
authors: J
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authors: Richardson
authors: Freeman Hospital , Newcastle upon Tyne , UK.
authors: M
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authors: Egred
authors: Golden Jubilee National Hospital , Clydebank , UK.
authors: M
authors: M
authors: McEntegart
authors: Golden Jubilee National Hospital , Clydebank , UK.
authors: A
authors: A
authors: Shaukat
authors: Golden Jubilee National Hospital , Clydebank , UK.
authors: K
authors: K
authors: Oldroyd
authors: Royal Bournemouth Hospital , Bournemouth , UK.
authors: G
authors: G
authors: Vishwanathan
authors: Royal Bournemouth Hospital , Bournemouth , UK.
authors: O
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authors: Rana
authors: Royal Bournemouth Hospital , Bournemouth , UK.
authors: S
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authors: Talwar
authors: Forth Valley Royal Hospital , Larbert , UK.
authors: M
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authors: McPherson
authors: Bristol Royal Infirmary , Bristol , UK.
authors: J W
authors: JW
authors: Strange
authors: Belfast City Hospital , Belfast , UK.
authors: C G
authors: CG
authors: Hanratty
authors: Belfast City Hospital , Belfast , UK.
authors: S J
authors: SJ
authors: Walsh
authors: Forth Valley Royal Hospital , Larbert , UK.
authors: J C
authors: JC
authors: Spratt
authors: Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK.
authors: W H T
authors: WH
authors: Smith