Abstract 14215: Percutaneous Coronary Angioplasty of Chronic Total Occlusions. Is There a Learning Curve ?
Purpose: Percutaneous coronary angioplasty (PCI) of Coronary Chronic Total Occlusions (CTO) is still associated with a reduced success rate. Lesion- and patient- related factors of failure are well known, but the influence of operator experience influence has been less described. The purpose of this abstract is to describe the influence of the operator and known predictive factors on the success rate of CTO PCI (European CTO club definition) treated by several operators in our institution.
Methods: The study included 1,000 consecutive CTO PCI performed between Jan2004 and Dec 2009 by 13 operators. In order to assess the learning curve, an index of individual operator experience during the study was defined as 1 for the first 50 cases, 2 for next fifty, up to 6 for operators with > 250 cases. PCI performed by the 2 main operators were compared with 11 others.
Results: A multivariate logistic regression analysis was performed in the whole population using all factors with a p value <0.2 by univariate analysis. Previous CABG (0R 0.44; p= 0.015), no visible stump (OR 0.61; p= 0.031), calcifications (0–3)(OR 0.78; p= 0.009) and the occlusion length (OR 0.98; p= 0.000; 2% failure for each mm of occlusion length) were found to be independent predictors of failure. The operator's experience was a predictor of success (OR 1.24; p= 0.002) but the year of treatment in the whole group was not. Here are the success rates and predictors value in patients treated by 2 main operators and others.
Conclusions: Individual experience of the operator but not of the whole team is a strong predictor of CTO PCI success despite a higher incidence of predictors of failure.
- © 2010 by American Heart Association, Inc.