Retrograde techniques and the impact of operator volume on percutaneous intervention for coronary chronic total occlusions an early U.S. experience

Our purpose was to determine if "Japanese style" technical strategies can be successfully applied in the U.S. practice environment and to better understand the learning curve for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Procedural technical success remains th...

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Bibliographic Details
Published in:JACC. Cardiovascular interventions 2009-09, Vol.2 (9), p.834-842
Main Authors: Thompson, Craig A, Jayne, John E, Robb, John F, Friedman, Bruce J, Kaplan, Aaron V, Hettleman, Bruce D, Niles, Nathaniel W, Lombardi, William L
Format: Article
Language:English
Subjects:
Aged
Angioplasty, Balloon, Coronary - adverse effects
Angioplasty, Balloon, Coronary - instrumentation
Angioplasty, Balloon, Coronary - methods
Angioplasty, Balloon, Coronary - utilization
Chronic Disease
Clinical Competence
Coronary Angiography
Coronary Occlusion - diagnostic imaging
Coronary Occlusion - therapy
Female
Humans
Japan
Learning
Logistic Models
Male
Middle Aged
Risk Assessment
Risk Factors
Stents
Time Factors
Treatment Outcome
Ultrasonography, Interventional
United States
Workload
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Summary:Our purpose was to determine if "Japanese style" technical strategies can be successfully applied in the U.S. practice environment and to better understand the learning curve for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Procedural technical success remains the major limiting factor for CTO PCI, and has been unchanged over time. Demographic, procedural, and outcome data were collected on 636 consecutive patients between January 2005 and March 2008 having CTO PCI (514 antegrade, 122 retrograde attempts) at 2 U.S. medical centers. Operators were divided into 2 groups: higher CTO volume, retrograde operators (ROs) (>75 total CTO PCI cases and >20 retrograde attempts during the study period) and lower CTO volume, nonretrograde operators (NROs) to evaluate the impact of CTO-specific operator case volume and retrograde techniques on procedural outcomes. Two operators met the criteria for RO category and 10 were NRO. ROs performed 395 CTO PCI cases (mean total CTO case experience = 197.5, 60 retrograde) and NROs performed 241 CTO PCI cases (mean total CTO case experience = 24.1,
ISSN:1876-7605
DOI:10.1016/j.jcin.2009.05.022