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Complex high-risk and indicated percutaneous coronary intervention for stable angina: Does operator volume influence patient outcome?

Complex high-risk and indicated percutaneous coronary intervention for stable angina: Does operator volume influence patient outcome?
Complex high-risk and indicated percutaneous coronary intervention for stable angina: Does operator volume influence patient outcome?

BACKGROUND: Complex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly studied.

OBJECTIVE: To define temporal changes in CHIP-PCI volumes, and the relationship between operator CHIP-PCI volume and patient outcomes.

METHODS AND RESULTS: Data were analyzed on all CHIP-PCI procedures undertaken for stable angina in England and Wales between 2007 and 2014. Operator volume data was available for 2012-14. CHIP-PCI was defined by patient characteristics (age ≥80years, left ventricular (LV) ejection fraction <30%, previous CABG, or chronic renal failure) and/or by procedural characteristics (left main PCI, chronic total occlusion PCI, LV support, use of rotational atherectomy or laser atherectomy). CHIP-PCI as a percentage of total PCI increased from 28.1% in 2007 to 36.2% in 2014 (P < .001). Between 2012 and 2014, a total of 30,268 CHIP-PCI cases were performed. Total operator volume varied from 1 to 580 cases with median total operator volume of 29 cases. Higher operator volumes were associated with a greater degree of patient comorbidity and increasing procedural complexity. After adjustment for baseline difference, in-hospital major bleeding (P < .001 for trend), access site complications (P < .001) and coronary perforation (P = .002) were associated with increasing operator CHIP-PCI volumes. However, the frequency of in-hospital death (P = .394) and 12-month mortality (P = .638) were similar across the volume quartiles. Higher volumes quartiles were associated with a greater likelihood of same day discharge (P < .001).

CONCLUSIONS: CHIP-PCI cases are an increasingly large population in contemporary PCI practice. Higher operator volumes were not associated with improved 12-month survival.

CONDENSED ABSTRACT: Data were analyzed on all complex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) procedures in England and Wales between 2007 and 2014. CHIP-PCI as a percentage of total PCI increased from 28.1% in 2007 to 36.2% in 2014 (P < .001). Median total operator volume was 29 cases with higher volumes associated with more patient comorbidity and increasing procedural complexity. In-hospital major bleeding (P < .001 for trend), access site complications (P < .001) and coronary perforation (P = .002) all associated with increasing operator CHIP-PCI volumes. However, trends for in-hospital death (P = .394), and 12-month mortality (P = .638) were similar across the volume quartiles.

0002-8703
15-25
Kinnaird, Tim
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Gallagher, Sean
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Spratt, James C
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Ludman, Peter
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de Belder, Mark
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Copt, Samuel
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Anderson, Richard
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Walsh, Simon
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Hanratty, Colm
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Curzen, Nick
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Banning, Adrian
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Mamas, Mamas
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Curzen, Nicholas
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Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Gallagher, Sean
2c8d69a0-9362-4dd2-b5ae-14ef988e5807
Spratt, James C
deae4630-0fda-4846-a6a2-1c222cf8384a
Ludman, Peter
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de Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Copt, Samuel
32842f37-50b6-476a-88bd-cf186e8bb58c
Anderson, Richard
da4bdca7-6e10-4e0f-9974-aaf9eca8cf8a
Walsh, Simon
60209c1f-ede5-47bf-b112-32442e61263a
Hanratty, Colm
ae336120-ee01-46a0-a74a-31847acf08e6
Curzen, Nick
c590bddc-f851-4b94-b3b8-00120e8a87ef
Banning, Adrian
c4929c3c-bbd4-4d99-8ff0-9b5526162070
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4

Kinnaird, Tim, Gallagher, Sean, Spratt, James C, Ludman, Peter, de Belder, Mark, Copt, Samuel, Anderson, Richard, Walsh, Simon, Hanratty, Colm, Curzen, Nick, Banning, Adrian, Mamas, Mamas and Curzen, Nicholas (2020) Complex high-risk and indicated percutaneous coronary intervention for stable angina: Does operator volume influence patient outcome? American Heart Journal, 222, 15-25. (doi:10.1016/j.ahj.2019.12.019).

Record type: Article

Abstract

BACKGROUND: Complex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) is an emerging concept that is poorly studied.

OBJECTIVE: To define temporal changes in CHIP-PCI volumes, and the relationship between operator CHIP-PCI volume and patient outcomes.

METHODS AND RESULTS: Data were analyzed on all CHIP-PCI procedures undertaken for stable angina in England and Wales between 2007 and 2014. Operator volume data was available for 2012-14. CHIP-PCI was defined by patient characteristics (age ≥80years, left ventricular (LV) ejection fraction <30%, previous CABG, or chronic renal failure) and/or by procedural characteristics (left main PCI, chronic total occlusion PCI, LV support, use of rotational atherectomy or laser atherectomy). CHIP-PCI as a percentage of total PCI increased from 28.1% in 2007 to 36.2% in 2014 (P < .001). Between 2012 and 2014, a total of 30,268 CHIP-PCI cases were performed. Total operator volume varied from 1 to 580 cases with median total operator volume of 29 cases. Higher operator volumes were associated with a greater degree of patient comorbidity and increasing procedural complexity. After adjustment for baseline difference, in-hospital major bleeding (P < .001 for trend), access site complications (P < .001) and coronary perforation (P = .002) were associated with increasing operator CHIP-PCI volumes. However, the frequency of in-hospital death (P = .394) and 12-month mortality (P = .638) were similar across the volume quartiles. Higher volumes quartiles were associated with a greater likelihood of same day discharge (P < .001).

CONCLUSIONS: CHIP-PCI cases are an increasingly large population in contemporary PCI practice. Higher operator volumes were not associated with improved 12-month survival.

CONDENSED ABSTRACT: Data were analyzed on all complex high-risk and indicated revascularization using percutaneous coronary intervention (CHIP-PCI) procedures in England and Wales between 2007 and 2014. CHIP-PCI as a percentage of total PCI increased from 28.1% in 2007 to 36.2% in 2014 (P < .001). Median total operator volume was 29 cases with higher volumes associated with more patient comorbidity and increasing procedural complexity. In-hospital major bleeding (P < .001 for trend), access site complications (P < .001) and coronary perforation (P = .002) all associated with increasing operator CHIP-PCI volumes. However, trends for in-hospital death (P = .394), and 12-month mortality (P = .638) were similar across the volume quartiles.

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More information

Accepted/In Press date: 22 December 2019
e-pub ahead of print date: 7 January 2020
Published date: April 2020

Identifiers

Local EPrints ID: 439524
URI: http://eprints.soton.ac.uk/id/eprint/439524
ISSN: 0002-8703
PURE UUID: 61df1bf9-8f87-4760-b463-a040d3febc36
ORCID for Nicholas Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 24 Apr 2020 16:44
Last modified: 28 Apr 2022 01:55

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Contributors

Author: Tim Kinnaird
Author: Sean Gallagher
Author: James C Spratt
Author: Peter Ludman
Author: Mark de Belder
Author: Samuel Copt
Author: Richard Anderson
Author: Simon Walsh
Author: Colm Hanratty
Author: Nick Curzen
Author: Adrian Banning
Author: Mamas Mamas
Author: Nicholas Curzen ORCID iD

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