Operator volume and outcomes of primary angioplasty for acute myocardial infarction in a single high-volume centre

Abstract

The guidelines for the management of ST-elevation myocardial infarction (STEMI) state the minimum operator volume for percutaneous coronary interventions (PCIs), without strong evidence of a relationship between operator volume and outcomes of primary angioplasty, at variance with elective practice. We sought to investigate the effect of operator volume on primary PCI for STEMI. Three hundred and thirty-one consecutive STEMI patients were treated over 19 months with primary PCI in a high-volume centre without on-site cardiac surgery. Three skilled operators, with very different volumes of interventional practice, performed the PCI procedures around-the-clock. Operators were divided into very high (A), intermediate high (B) and low high volume (C). Demographic, clinical, angiographic, and procedural characteristics of the patient population did not differ among operators, with the exception of three-vessel disease (P = 0.016), circumflex infarct-related artery (P = 0.002), mechanical support (P = 0.02), use of abciximab (P = 0.003) for operator C, use of tirofiban for operator B (P = 0.02), and type of stent for operator A (P = 0.0004). Similarly, no differences were observed among operators in in-hospital outcomes (death, a composite of major adverse cardiovascular events, ST-segment resolution, thrombolysis in myocardial infarction flow grade 3, length of hospitalization) and haemorrhagic complications. Our data show that there is not a significant relationship between operator volume over the threshold indicated by the guidelines, and both primary PCI early outcomes and complications in STEMI, and suggest that expertise and experience of the whole professional team rather than just of the individual operator play a major role.