Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
JACC Cardiovasc Interv. 2021 Jul 12;14(13):1423-1430. doi: 10.1016/j.jcin.2021.04.034. Epub 2021 Jun 16.
The aims of this study were to use a national percutaneous coronary intervention (PCI) registry to study temporal changes in procedure volumes of PCI using rotational atherectomy (ROTA-PCI), the patient and procedural factors associated with differing quartiles of operator ROTA-PCI volume, and the relationship between operator ROTA-PCI volumes and in-hospital patient outcomes.
Whether higher operator volume is associated with improved outcomes after ROTA-PCI is poorly defined.
Data from the British Cardiovascular Intervention Society national PCI database were analyzed for all ROTA-PCI procedures performed in the United Kingdom between 2013 and 2016. Individual logistic regressions were performed to quantify the independent association between annual operator ROTA-PCI volume and in-hospital outcomes.
In total, 7,740 ROTA-PCI procedures were performed, with a negatively skewed distribution and an annualized operator volume median of 2.5 procedures/year (range 0.25 to 55.25). Higher volume operators undertook more complex procedures in patients with greater comorbid burdens than lower volume operators. A significant inverse association was observed between operator ROTA-PCI volume and in-hospital mortality (odds ratio [OR]: 0.986/case; 95% confidence interval [CI]: 0.975 to 0.996; p = 0.007) and major adverse cardiac and cerebral events (OR: 0.983/case; 95% CI: 0.975 to 0.993; p < 0.001). Additionally, lower rates of emergency cardiac surgery (OR: 0.964/case; 95% CI: 0.939 to 0.991; p = 0.008), arterial complications (OR: 0.975/case; 95% CI: 0.975 to 0.982; p < 0.001) and in-hospital major bleeding (OR: 0.985/case; 95% CI: 0.977 to 0.993; p < 0.001) were associated with higher ROTA-PCI operator volume. Sensitivity analyses in several subgroups demonstrated a consistency of improved outcomes as annual ROTA-PCI volume increased. An annual volume of <4 ROTA-PCI procedures/year was observed to be associated with increased major adverse cardiac and cerebral events, with 239 of 432 operators (55%) not exceeding this threshold.
In-hospital adverse outcomes occurred less frequently as ROTA-PCI operator volume increased. These data suggest that operator volume is an important factor determining outcome after ROTA-PCI.
本研究旨在利用全国经皮冠状动脉介入治疗（PCI）注册研究，探讨使用旋转切割（ROTA-PCI）行 PCI 的术式量的时间变化，以及与术者 ROTA-PCI 术式量不同四分位数相关的患者和手术因素，以及术者 ROTA-PCI 术式量与住院患者结局之间的关系。
术者术式量与 ROTA-PCI 术后结局改善之间的关系尚未明确。
对 2013 年至 2016 年期间在英国进行的所有 ROTA-PCI 手术的英国心血管介入学会全国 PCI 数据库数据进行分析。采用个体逻辑回归来量化术者 ROTA-PCI 术式量的年度变化与住院期间结局之间的独立关联。
共进行了 7740 例 ROTA-PCI 手术，呈负偏态分布，术者年平均 ROTA-PCI 术式量中位数为 2.5 例/年（范围 0.25 至 55.25）。与低术者术式量相比，高术者术式量的术者为更多合并症患者进行了更复杂的手术。术者 ROTA-PCI 术式量与住院期间死亡率（比值比 [OR]：0.986/例；95%置信区间 [CI]：0.975 至 0.996；p=0.007）和主要心脑不良事件（OR：0.983/例；95%CI：0.975 至 0.993；p<0.001）呈显著负相关。此外，较低的紧急心脏手术（OR：0.964/例；95%CI：0.939 至 0.991；p=0.008）、动脉并发症（OR：0.975/例；95%CI：0.975 至 0.982；p<0.001）和住院期间大出血（OR：0.985/例；95%CI：0.977 至 0.993；p<0.001）的发生率与较高的 ROTA-PCI 术者术式量相关。在几个亚组的敏感性分析中，随着 ROTA-PCI 术者术式量的增加，观察到结局改善的一致性。每年 ROTA-PCI 术式量<4 例与主要心脑不良事件增加相关，432 名术者中有 239 名（55%）未超过该阈值。
随着 ROTA-PCI 术者术式量的增加，住院期间不良结局的发生频率降低。这些数据表明，术者术式量是决定 ROTA-PCI 术后结局的一个重要因素。
