Operator volume and outcomes in 12,988 percutaneous coronary interventions

Objectives. We sought to determine whether there is a relation between operator volume and outcomes for percutaneous coronary interventions (PCIs). Background. A 1993 American College of Cardiology/American Heart Association tack force stated that cardiologists should perform greater than or equal to 75 procedures/year to maintain competency in PCHs; however, there were limited data available to support this statement. Methods. Data were collected from 1990 through 1993 on 12,988 PCIs (12,118 consecutive hospital admissions) performed by 31 cardiologists at two hospitals in New Hampshire and two in Maine and one hospital in Massachusetts supporting these procedures, Operators were categorized into terciles based on annualized volume of procedures. Univariate and multivariate regression analyses were used to control for case-mix. Successful outcomes included angiographic success (all lesions attempted dilated to <50% residual stenosis) and clinical success (at least one lesion dilated to <50% residual stenosis rand no adverse outcomes), in-hospital adverse outcomes included coronary artery bypass graft surgery (CABG, myocardial infarction (MI) and death. Results. After adjustment for case-mix, higher angiographic (low, middle and high terciles: 84.7%, 86.1% and 90.3%, p-trend 0.006) and clinical success rates (85.5%, 88.0% and 90.7%, p-trend 0.025), with fewer referrals to CABG (4.54%, 3.75% and 2.49%, p-trend <0.001), were seen as operator volume increased, There mas a trend toward higher MI rates for high volume operators (2.00%, 1.98% and 2.57%, p-trend 0.05); all terciles had similar in-hospital mortality sates (1.09%, 0.96% and 1.05%, p-trend 0.8). Conclusions. There is a significant relation between operator volume and outcomes in PCIs. Efforts should he directed toward understanding why high volume operators are more successful and encounter fewer adverse outcomes. (C) 1998 by the American College of Cardiology.