Association of Annual Operator Volume With the Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention
Judit Karácsonyi, Ioannis Tsiafoutis, Khaldoon Alaswad, Dimitrios Karmpaliotis, James W. Choi, Jaikirshan Khatri, Farouc A. Jaffer, Paul Poommipanit, Mitul Patel, Şevket Görgülü, Robert W. Yeh, Basem Elbarouni, Ahmed ElGuindy, Oleg Krestyaninov, Evangelia Vemmou, Ilias Nikolakopoulos, Spyridon Kostantinis, Bahadir Simsek, Bavana V. Rangan, Imre Ungi, Khalid Tammam, Nidal Abi Rafeh, Ömer Göktekín, Emmanouil S. Brilakis, Michalis Koutouzis
Abstract
OBJECTIVES: There are limited data on the association of operator volume with the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS: We analyzed the association between operator volume and procedural outcomes of 7035 CTO-PCIs performed between 2012 and February 2021 at 30 centers. RESULTS: The study population was divided into 3 groups based on annual operator CTO-PCI volume: low-volume operators (LVO: <30 cases/year; 39.7% of the cases); medium-volume operators (MVO: 30-60 cases/year; 25.7% of the cases); and high-volume operators (HVO: >60 cases/ year; 34.6% of the cases). Mean patient age was 64.4 ± 10 years and 82% were men. Cases performed by HVOs were more complex, with higher J-CTO score compared with cases performed by MVOs and LVOs (2.72 ± 1.27 vs 2.39 ± 1.19 vs 2.12 ± 1.27, respectively; P<.001). Moderate/severe proximal vessel tortuosity (35% vs 23% vs 20%; P<.001) and proximal cap ambiguity (44% vs 34% vs 32%; P<.001) was also more common in the HVO group. Cases performed by HVOs had higher technical success rates (87.9% vs 86.9% vs 82.6%; P<.001), but also higher rates of periprocedural major cardiac adverse events compared with MVOs and LVOs (3.08% vs 2.71% vs 1.50%; P<.01). On multivariable analyses, HVOs and MVOs were associated with higher technical success. CONCLUSIONS: In a contemporary, multicenter registry, 40% of CTO-PCI cases are performed by LVOs performing <30 cases per year. Cases performed by HVOs were associated with higher technical and procedural success, but also higher periprocedural major complication rates, potentially due to higher lesion complexity.