Karacsonyi Judit, Tsiafoutis Ioannis, Alaswad Khaldoon, Karmpaliotis Dimitrios, Choi James W, Khatri Jaikirshan, Jaffer Farouc A, Poommipanit Paul, Patel Mitul, Gorgulu Sevket, Yeh Robert, Elbarouni Basem, ElGuindy Ahmed, Krestyaninov Oleg, Vemmou Evangelia, Nikolakopoulos Ilias, Kostantinis Spyridon, Simsek Bahadir, Rangan Bavana V, Ungi Imre, Tammam Khalid, Abi Rafeh Nidal, Goktekin Omer, Brilakis Emmanouil S, Koutouzis Michalis
Red Cross General Hospital, 1 Athanasaki St, 11526, Athens, Greece.
J Invasive Cardiol. 2022 Sep;34(9):E645-E652. doi: 10.25270/jic/22.00024. Epub 2022 Aug 5.
There are limited data on the association of operator volume with the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
We analyzed the association between operator volume and procedural outcomes of 7035 CTO-PCIs performed between 2012 and February 2021 at 30 centers.
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.
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.
关于术者手术量与慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）结果之间关联的数据有限。
我们分析了2012年至2021年2月期间在30个中心进行的7035例CTO-PCI手术中术者手术量与手术结果之间的关联。
根据术者每年CTO-PCI手术量，将研究人群分为3组：低手术量术者（LVO：<30例/年；占病例的39.7%）；中等手术量术者（MVO：30-60例/年；占病例的25.7%）；高手术量术者（HVO：>60例/年；占病例的34.6%）。患者平均年龄为64.4±10岁，82%为男性。与MVO和LVO所做的病例相比，HVO所做的病例更复杂，J-CTO评分更高（分别为2.72±1.27、2.39±1.19和2.12±1.27；P<0.001）。中度/重度近端血管迂曲（35%对23%对20%；P<0.001）和近端帽模糊（44%对34%对32%；P<0.001）在HVO组中也更常见。HVO所做的病例技术成功率更高（87.9%对86.9%对82.6%；P<0.001），但与MVO和LVO相比，围手术期主要心脏不良事件发生率也更高（3.08%对2.71%对1.50%；P<0.01）。在多变量分析中，HVO和MVO与更高的技术成功率相关。
在一个当代多中心注册研究中，40%的CTO-PCI病例由每年手术量<30例的LVO进行。HVO所做的病例与更高的技术和手术成功率相关，但围手术期主要并发症发生率也更高，这可能是由于病变复杂性更高。
