A. Kastrati et al., OPERATOR VOLUME AND OUTCOME OF PATIENTS UNDERGOING CORONARY STENT PLACEMENT, Journal of the American College of Cardiology, 32(4), 1998, pp. 970-976
Objectives. The aim of this study was to assess the relation between o
perator experience in coronary stent placement procedures and the clin
ical outcome of patients. Background. The results of coronary balloon
angioplasty are closely related to the experience of the operator perf
orming the procedure, Data on the effect of operator experience on the
results after coronary stent placement are missing. Methods. The stud
y included 3,409 consecutive patients undergoing coronary stent placem
ent for the management of coronary artery disease. A composite end poi
nt of cardiac death, myocardial infarction and aortocoronary bypass su
rgery during the first 30 days after the intervention, was the primary
end point and the procedural failure was the secondary end point of t
he study. Results. Adverse clinical outcome occurred in 2.99% of the 3
,409 patients undergoing coronary stent placement. Procedural failure
was recorded in 2.08% of the patients. Operator volumes above 483 proc
edures were associated with a risk-adjusted adverse outcome rate of 1.
70% +/- 1.28%, which is significantly lo,ver than the overall rate of
2.99%. Operator yearly volumes of under 90 procedures were associated
with a risk-adjusted adverse outcome rate of 4.59% +/- 1.17%, which is
significantly higher than the overall rate of 2.99%. The operator exp
erience was an independent predictor even after adjusting for the effe
ct of other risk factors. The analysis demonstrated that an experience
of at least 100 procedures is required to obtain better outcome even
in patients with simple coronary lesions and that operators should per
form at least 70 procedures annually to expect a better outcome in pat
ients,with both simple and complex coronary lesions, Conclusions. Oper
ator experience is a significant and independent predictor of the outc
ome of patients undergoing coronary stent placement. An experience of
at least 100 procedures and an annual volume of at least 70 procedures
are required to ensure a significantly better outcome after coronary
stent implantation. (C) 1998 by the American College of Cardiology.