Author + information
- Received May 5, 2016
- Revision received July 19, 2016
- Accepted August 11, 2016
- Published online October 24, 2016.
- S1936879816313140-aeb8029ffc2b140d2df69686d487c38cBo Xu, MBBSa,
- S1936879816313140-0ba8aa66fa0f28b923bafae7fcc6c759Björn Redfors, MD, PhDb,c,
- S1936879816313140-60bd9098c4cc70501f67ee931ffc19b5Yuejin Yang, MDa,∗ (, )
- S1936879816313140-53f126c089230ba1073239d234f2a3e0Shubin Qiao, MDa,
- S1936879816313140-bf6410de5615d2def44128fe29e096fcYongjian Wu, MDa,
- S1936879816313140-682631548c32ae22f4a810576b82eb11Jilin Chen, MDa,
- S1936879816313140-e31a0df60418af3f7662018abb56184dHaibo Liu, MDa,
- S1936879816313140-975680d4eb4e41f4d2f3e22f7fdb3b4dJue Chen, MDa,
- S1936879816313140-7084528f1b95c1d081ed8f68879facb6Liang Xu, MSca,
- S1936879816313140-6e5f556efe2e1688699598d188cd3cc5Yanyan Zhao, BSa,
- S1936879816313140-c6762ece10be84fa76f11c47d6f89922Changdong Guan, MSca,
- S1936879816313140-ba9c9ed426609d39add93d93876c5927Runlin Gao, MDa,∗ ( and )
- S1936879816313140-6e81946e359ca527a12a57d8d62cd1b0Philippe Généreux, MDb,d,e,f
- aFu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- bCardiovascular Research Foundation, New York, New York
- cSahlgrenska University Hospital, Gothenburg, Sweden
- dNew York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- eHôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada
- fMorristown Medical Center, Morristown, New Jersey
- ↵∗Reprint requests and correspondence:
Dr. Runlin Gao or Yuejin Yang, Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng District, 100037 Beijing, China.
Objectives The aim of this study was to assess the impact of operator experience on prognosis after left main coronary artery (LM) percutaneous coronary intervention (PCI).
Background LM PCI can be technically challenging and potentially risky considering the amount of supplied myocardium.
Methods Consecutive patients who underwent unprotected LM PCI at a single institution were included and compared according to whether the primary operator was an experienced, high-volume LM operator (defined as an operator who performed at least 15 LM PCIs per year for at least 3 consecutive years) or not. Kaplan-Meier estimates and Cox proportional hazards models are presented.
Results From January 2004 to December 2011, a total of 1,948 patients underwent unprotected LM PCI by 25 operators. Of these, 7 operators (28%) were considered experienced, and 18 (72%) were considered less experienced, with an overall mean experience of 12.0 ± 11.5 LM PCIs per year. LM PCI was performed in 1,422 patients (73%) by experienced operators and in 526 patients (27%) by less experienced operators. Patients treated by experienced operators had more complex and extensive coronary artery disease. Unadjusted and adjusted risks for cardiac death were lower for patients who were treated by experienced operators, both at 30-day (unadjusted hazard ratio [HR]: 0.23; 95% confidence interval [CI]: 0.09 to 0.60; p = 0.003; adjusted HR: 0.22; 95% CI: 0.09 to 0.59; p = 0.003) and 3-year (unadjusted HR: 0.53; 95% CI: 0.32 to 0.89, p = 0.02; adjusted HR: 0.49; 95% CI: 0.29 to 0.84; p = 0.009) follow-up. Discrimination improved when operator experience was added to Cox proportional hazards models containing the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score (integrated discriminatory index = 0.004, p = 0.03) or SYNTAX score II (integrated discriminatory index = 0.007, p = 0.02). No significant interaction was detected between operator experience and distal bifurcation LM lesion, 2-stent bifurcation stenting, and intravascular ultrasound use (p > 0.10 for all).
Conclusions Patients who underwent LM PCI by high-volume and experienced operators had better short- and long-term prognoses. Operator experience is an important factor in a complex intervention such as LM PCI.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Xu and Redfors contributed equally to this work.
- Received May 5, 2016.
- Revision received July 19, 2016.
- Accepted August 11, 2016.
- American College of Cardiology Foundation