Author + information
- 1Massachusetts General Hospital, Boston, Massachusetts, United States
- 2MGH, Boston, Massachusetts, United States
- 3Duke Clinical Research Institute, Durham, North Carolina, United States
- 4Duke University Medical Center, Durham, North Carolina, United States
- 5Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Advances in CTO techniques have led to rising procedural success rates among experienced operators. The learning curve for new CTO operators has not been well-defined.
From the NCDR CathPCI Registry, 93,875 CTO PCI cases were extracted between July 2009 and December 2015. We delineated a cohort of “emerging operators” who initially performed few CTO PCIs (<10 cases per given year). Among these, we then identified “rapid adopters” who subsequently performed >20 cases in a given year. In-hospital outcomes for CTO PCIs were stratified by the number of cases previously performed by an operator. Multivariable regression models were used to estimate clinical outcomes by operator case number. We defined MACE as the composite of death, MI, stroke, tamponade, or urgent CABG.
Among 7,251 emerging CTO PCI operators, 148 were rapid adopters who increased CTO PCI volume to >20 per year subsequently. Overall, MACE rate was 4.3%, bleeding 4.0%, MI 2.0%, mortality 0.6%, tamponade 0.3%, and renal failure 0.2%. Adjusted regression models based on CTO case number showed linear improvements in procedural outcomes at the expense of increased contrast use, fluoroscopy use, and bleeding (Figure 1). MACE rates were stable after initial operator experience.
Among a large number of emerging CTO PCI operators, only a small fraction had a rapidly growing volume. As operator experience grew with increasing case number, a procedural learning curve was observed for technical success while MACE was unchanged.
CORONARY: PCI Outcomes