Complex and Higher Risk Procedures for Indicated Patients (CHIP)
Annual Operator Volume Among Patients Treated Using Percutaneous Coronary Interventions With Rotational Atherectomy and Procedural Outcomes - Analysis Based on a Large National Registry
Rafal Januszek1, Wojciech Wanha2, Zbigniew Siudak3, Krzysztof Malinowski4, Wojciech Wojakowski2, Krzysztof Reczuch5, Sławomir Dobrzycki6, Maciej Lesiak7, Robert Gil8, Adam Witkowski9, Stanisław Bartuś4
University Hospital in Cracow, Poland1, Medical University of Silesia, Poland2, Jan Kochanowski University, Poland3, Jagiellonian University Medical College, Poland4, Wroclaw Medical University, Poland5, Medical University of Białystok, Poland6, Poznan University of Medical Sciences, Poland7, Centre for Postgraduate Medical Education, Poland8, National Institute of Cardiology, Poland9
Low operator and institutional volume are associated with poorer procedural and long-term clinical outcomes in the general population of patients treated with percutaneous coronary interventions (PCI). The aim of the current study was to assess the relationship between operator experience and procedural outcomes of patients treated with PCI and rotational atherectomy (RA).
Data for conducting the current analysis were obtained from the national registry of percutaneous coronary interventions (ORPKI) maintained in cooperation with the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The study covers data from January 2014 to December 2020.
During the investigated period, there were 162 active CathLabs, at which 747,033 PCI procedures were performed by 851 operators (377 RA operators [44.3%]). Of those, 5,188 were PCI with RA procedures; average 30 ± 61 per site/7 years (Me: 3; Q1-Q3: 0-31); 6 ± 18 per operator/7 years (Me: 0; Q1-Q3: 0-3). Considering the number of RA procedures annually performed by individual operators during the analysed 7 years, the 1st quartile totalled (Q1: <=2.57 ), the 2nd (Q2: <=5.57), and the 3rd (Q3: <=11.57), while the 4th quartile was (Q4: >11.57). The maximum number of procedures was 39.86 annually per operator. We demonstrated, through a nonlinear relationship with annualised operator volume and risk-adjusted, that operators performing more than 30 PCI with RA per year have a lower number of the overall periprocedural complications (p=0.019).
High-volume RA operators are related to lower overall periprocedural complication occurrence in patients treated with RA in comparison to low-volume operators.