Protty Majd B, Hasan Saad, Premawardhana Diluka, Addin Mohammed Shugaa, Morgan Holly, Bundhoo Shantu, Hussain Hussain, Ul-Haq Zia, Chase Alexander, Hildick-Smith David, Choudhury Anirban, Kinnaird Tim, Hailan Ahmed
Sir Geraint Evans Cardiovascular Research Building, Cardiff University, Cardiff, South Glamorgan, UK.
Morriston Cardiac Centre, Swansea, UK.
Open Heart. 2025 Jan 30;12(1):e003131. doi: 10.1136/openhrt-2024-003131.
Training in complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) has frequently been reserved for established operators (consultants/attending) with trainees (fellows-in-training or FIT) being often discouraged from carrying out such procedures as a primary operator due to their high-risk nature. Whether the outcomes of these cases differ if the primary operator is a supervised FIT compared with a consultant is unknown.
Using multicentre PCI data from three cardiac centres in South Wales, UK (2018-2022), we identified 2295 CHIP-PCI cases with a UK-BCIS CHIP Score of 3 or more. These were then divided by primary operator status (supervised FIT vs consultant); the primary outcome was in-hospital major adverse cardiac events (IH-MACCE). Multivariate logistic models were developed to adjust for differences in baseline and procedural characteristics.
The primary operator in 838 (36%) of the PCIs was a supervised FIT. Baseline and procedural characteristics had lower complexity in CHIP-PCI cases carried out by supervised FIT vs consultant. In a multivariate-adjusted model, supervised FIT procedures were associated with lower odds of concurrent valve disease (OR 0.45, 95% CI: 0.29 to 0.69), dual access (OR 0.58, 95% CI: 0.41 to 0.83), cutting/scoring balloons (OR 0.59, 95% CI: 0.44 to 0.79) and rotational atherectomy (OR 0.60, 95% CI: 0.42 to 0.87). After adjusting for all variables, however, there was no difference in the primary outcome (OR 0.72, 95% 0.34 to 1.51) or any secondary outcomes. Sensitivity analyses restricted to patients with higher CHIP Scores (4+ and 5+) showed comparable IH-MACCE.
Training FIT as primary operators in CHIP-PCI appears to be feasible and safe and can be delivered within the standard training programme. The comparable outcomes are likely driven by the two-operator 'buddy' effect that a FIT supervised by a consultant benefits from.
复杂高危经皮冠状动脉介入治疗（CHIP-PCI）的培训通常只针对经验丰富的术者（顾问医师/主治医生），由于其高风险性质，实习医生（培训学员或FIT）往往不被鼓励作为主要术者进行此类手术。与顾问医师相比，如果主要术者是受监督的FIT，这些病例的结果是否不同尚不清楚。
利用英国南威尔士三个心脏中心（2018 - 2022年）的多中心PCI数据，我们确定了2295例英国心脏介入学会（UK-BCIS）CHIP评分3分及以上的CHIP-PCI病例。然后根据主要术者身份（受监督的FIT与顾问医师）进行划分；主要结局是院内主要不良心脏事件（IH-MACCE）。建立多变量逻辑模型以调整基线和手术特征的差异。
838例（36%）PCI手术的主要术者是受监督的FIT。与顾问医师相比，受监督的FIT进行的CHIP-PCI病例的基线和手术特征复杂性较低。在多变量调整模型中，受监督的FIT手术并发瓣膜疾病（OR 0.45，95%CI：0.29至0.69）、双入路（OR 0.58，95%CI：0.41至0.83）、切割/刻痕球囊（OR 0.59，95%CI：0.44至0.79）和旋磨术（OR 0.60，95%CI：0.42至0.87）的几率较低。然而，在调整所有变量后，主要结局（OR 0.72，95% 0.34至1.51）或任何次要结局均无差异。仅限于CHIP评分较高（4+和5+）患者的敏感性分析显示IH-MACCE相当。
培训FIT作为CHIP-PCI的主要术者似乎是可行和安全的，并且可以在标准培训计划内进行。可比的结局可能是由顾问医师监督的FIT所受益的双术者“伙伴”效应驱动的。
