Experience = better outcomesA recent study shows that physicians with more experience implanting stents have better results than those with less.1 It had been shown that more experience performing balloon angioplasty resulted in more successful procedures, but some experts believed operator experience would not play as important a role in stents.
Adnan Kastrati, MD, et al. analyzed data from 3,409 consecutive patients with a stent implanted by one of 10 physicians at a single hospital in Munich, Germany. After adjusting for differences in baseline risk factors, the rate of adverse events was 1.7% for patients treated by physicians who performed the procedure often vs. 4.69% for those who performed the procedure less often. "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," states the conclusion.
The findings suggest that current American College of Cardiology/American Heart Association guidelines for balloon angioplasty, which recommend that physicians perform at least 75 procedures each year to maintain competency, are probably valid for stent procedures as well.
The German researchers also found that low-volume operators could successfully treat patients at low risk for complications. "We now have data that illustrate that we can match the operator’s experience with the risk of each patient," writes Kastrati. However, he emphasizes, "Even for operators treating very low-risk patients, a minimum number of procedures is necessary."
1. Kastrati A, Neumann F, Schomig A. Operator volume and outcome of patients undergoing coronary stent placement. J Am Coll Cardiol 1998; 32:970-976.