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Influence of a long-term proctoring process on the effectiveness of chronic total occlusion percutaneous coronary interventions
Affiliations- Department of Cardiology and Internal Diseases, Military Institute of Medicine in Warsaw, Warszawa, Poland
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
- Department of Cardiology and Angiology II, University Heart Center Freiburg in Bad Krozingen, Germany
- SGH Warsaw School of Economics, Warszawa, Poland
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Abstract
Background: Despite the complexity of the chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures and unsatisfactory results in centers with low volume experience, the practice of training and certifying operators is not a routine.
Aims: The study aimed to identify factors influencing the effectiveness and complications of PCI CTOs during a proctoring program.
Methods: The study group consisted of 194 consecutive patients (226 PCI CTOs) as part of the proc-toring program. The relationships between clinical and treatment parameters and the experience gained along with the duration of the proctoring program on the effectiveness and safety of the procedure were assessed.
Results: The multivariable analysis showed an independent effect of CTO morphology (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.21–0.71; P <0.01) and an independent effect of increasing operator’s experience (OR, 2.62; 95% CI, 1.24–5.60; P = 0.01) on the effectiveness of the procedure. The increase in the efficiency of the PCI CTO, related to the treatment experience gained during the program, was observed especially in the first 50 procedures, treatment effectiveness increased from 55% to 72% (P <0.05). The success of procedures was higher in months when ≥3 procedures were performed (75% vs. 52%; P <0.001). Periprocedural complications occurred in 11 patients (4.9%). In the multivariable analysis, no independent factors influencing the risk of complications were identified.
Conclusions: The effectiveness of PCI CTO depended on lesion complexity and broadening oper-ator’s experience. No independent factors affecting the risk of complications were identified. The number of >50 procedures under the proctor’s supervision should be considered in designing teaching programs.
Abstract
Background: Despite the complexity of the chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures and unsatisfactory results in centers with low volume experience, the practice of training and certifying operators is not a routine.
Aims: The study aimed to identify factors influencing the effectiveness and complications of PCI CTOs during a proctoring program.
Methods: The study group consisted of 194 consecutive patients (226 PCI CTOs) as part of the proc-toring program. The relationships between clinical and treatment parameters and the experience gained along with the duration of the proctoring program on the effectiveness and safety of the procedure were assessed.
Results: The multivariable analysis showed an independent effect of CTO morphology (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.21–0.71; P <0.01) and an independent effect of increasing operator’s experience (OR, 2.62; 95% CI, 1.24–5.60; P = 0.01) on the effectiveness of the procedure. The increase in the efficiency of the PCI CTO, related to the treatment experience gained during the program, was observed especially in the first 50 procedures, treatment effectiveness increased from 55% to 72% (P <0.05). The success of procedures was higher in months when ≥3 procedures were performed (75% vs. 52%; P <0.001). Periprocedural complications occurred in 11 patients (4.9%). In the multivariable analysis, no independent factors influencing the risk of complications were identified.
Conclusions: The effectiveness of PCI CTO depended on lesion complexity and broadening oper-ator’s experience. No independent factors affecting the risk of complications were identified. The number of >50 procedures under the proctor’s supervision should be considered in designing teaching programs.
Keywords
chronic total occlusion, experience, percutaneous coronary intervention, proctoring, success
About this articleTitle
Influence of a long-term proctoring process on the effectiveness of chronic total occlusion percutaneous coronary interventions
Journal
Kardiologia Polska (Polish Heart Journal)
Issue
Article type
Original article
Pages
445-451
Published online
2022-02-13
Page views
3332
Article views/downloads
300
DOI
10.33963/KP.a2022.0042
Pubmed
Bibliographic record
Kardiol Pol 2022;80(4):445-451.
Keywords
chronic total occlusion
experience
percutaneous coronary intervention
proctoring
success
Authors
Katarzyna Żelazowska-Chmielińska
Wojciech Wąsek
Mirosław Ferenc
Bogumił Kamiński
Tomasz Przerwa
Paweł Krzesiński
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