Operator volume and outcome of patients undergoing coronary stent placement

Objectives. The aim of this study was to assess the relation between operator experience in coronary stent placement procedures and the clinical outcome of patients. Background. The results of coronary balloon angioplasty are closely related to the experience of the operator performing the procedure, Data on the effect of operator experience on the results after coronary stent placement are missing. Methods. The study included 3,409 consecutive patients undergoing coronary stent placement for the management of coronary artery disease. A composite end point of cardiac death, myocardial infarction and aortocoronary bypass surgery during the first 30 days after the intervention, was the primary end point and the procedural failure was the secondary end point of the study. Results. Adverse clinical outcome occurred in 2.99% of the 3,409 patients undergoing coronary stent placement. Procedural failure was recorded in 2.08% of the patients. Operator volumes above 483 procedures were associated with a risk-adjusted adverse outcome rate of 1.70% +/- 1.28%, which is significantly lo,ver than the overall rate of 2.99%. Operator yearly volumes of under 90 procedures were associated with a risk-adjusted adverse outcome rate of 4.59% +/- 1.17%, which is significantly higher than the overall rate of 2.99%. The operator experience was an independent predictor even after adjusting for the effect of other risk factors. The analysis demonstrated that an experience of at least 100 procedures is required to obtain better outcome even in patients with simple coronary lesions and that operators should perform at least 70 procedures annually to expect a better outcome in patients,with both simple and complex coronary lesions, Conclusions. Operator experience is a significant and independent predictor of the outcome of patients undergoing coronary stent placement. An experience of at least 100 procedures and an annual volume of at least 70 procedures are required to ensure a significantly better outcome after coronary stent implantation. (C) 1998 by the American College of Cardiology.