Document Detail

Impact of operator volume on overall major adverse cardiac events following direct coronary stent implantation versus stenting after predilatation.
MedLine Citation:
PMID:  15204167     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine the impact of operator experience on procedural, clinical and angiographic outcome after (direct) coronary stent implantation. BACKGROUND: Although for other forms of percutaneous coronary interventions an inverse relationship between operator volume and patient outcomes has been shown, the impact of operator volume on outcome after direct stenting has never been investigated. METHODS: A retrospective analysis was performed on data from a prospective randomized trial comparing direct stenting with that after predilatation. The trial consisted of 400 patients with stable and unstable angina pectoris and/or myocardial ischemia due to a coronary stenosis of a single native vessel eligible in 1999-2001 for direct stenting. For a single-center high-volume clinic (>1500 cases/year), the authors compared the most experienced operators (case load: >4000) with well trained practitioners (case load: 175). One hundred and fifteen patients were identified who were treated by high-volume and 180 who were treated by medium-volume operators. RESULTS: Baseline patient characteristics were evenly distributed among groups. High-volume, compared with medium-volume operators, were faster (30.8 versus 42.2 minutes, p < 0.001), needed less frequent postdilatation (15% versus 24%, p = 0.06) and had lower fluoroscopy times (7.5 versus 11.2 minutes, p < 0.001), lower contrast usage (180 versus 228 ml, p < 0.001), lower procedural costs (euro1982 versus euro2164, p = 0.05) and reduced rates of major adverse cardiac and cerebral event (MACCE) at six months (12.2 versus 21.1%, p = 0.03). The medium-volume operator group experienced higher angiographic binary restenosis rates after direct stenting compared with stenting after predilatation (31.5 versus 14.9%, p = 0.005). CONCLUSIONS: Stenting performed by high-volume operators resulted in a 50% reduction in MACCE as compared with medium-volume physicians, which also had twice as much restenosis when using direct stenting. Hence, the more demanding technique of direct stenting should not be performed by unsupervised operators who have not yet completed their training. Furthermore, prolonged training periods and even more intensive supervision by experienced operators seems mandatory.
Sander IJsselmuiden; Ferdinand Kiemeneij; Geertjan Tangelder; Ton Slagboom; Ron van der Wieken; Patrick Serruys; Gertjan Laarman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of cardiovascular interventions     Volume:  6     ISSN:  1462-8848     ISO Abbreviation:  Int J Cardiovasc Intervent     Publication Date:  2004  
Date Detail:
Created Date:  2004-06-18     Completed Date:  2004-07-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9815622     Medline TA:  Int J Cardiovasc Intervent     Country:  England    
Other Details:
Languages:  eng     Pagination:  5-12     Citation Subset:  IM    
Amsterdam Department of Interventional Cardiology-Onze Lieve Vrouwe Gasthuis Hospital, The Netherlands. A.J.J.IJSSELMUIDEN@OLVG.NL
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MeSH Terms
Balloon Dilatation
Coronary Angiography
Coronary Stenosis / therapy*
Follow-Up Studies
Middle Aged
Radiology, Interventional*
Retrospective Studies
Stents / adverse effects*
Time Factors

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