Percutaneous coronary intervention operator and institutional competency and volume
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]
Operator and Institutional Competency and Volume (DO NOT EDIT)[1]
| Class I |
| "1. Elective/urgent PCI should be performed by operators with an acceptable annual volume (greater than or equal to 75 procedures) at high-volume centers (more than 400 procedures) with on-site cardiac surgery.[2][3] (Level of Evidence: C)" |
| "2. Elective/urgent PCI should be performed by operators and institutions whose current risk-adjusted outcomes statistics are comparable to those reported in contemporary national data registries. (Level of Evidence: C)" |
| "3. Primary PCI for STEMI should be performed by experienced operators who perform more than 75 elective PCI procedures per year and, ideally, at least 11 PCI procedures for STEMI per year. Ideally, these procedures should be performed in institutions that perform more than 400 elective PCIs per year and more than 36 Primary PCI procedures for STEMI per year.[2][4][5][6][7] (Level of Evidence: C)" |
| Class III (No Benefit) |
| "1. It is not recommended that elective/urgent PCI be performed by low-volume operators (75 procedures per year) at low-volume centers (200 to 400 procedures per year) with or without on-site cardiac surgery. An institution with a volume of fewer than 200 procedures per year, unless in a region that is underserved because of geography, should carefully consider whether it should continue to offer this service.[2] (Level of Evidence: C)" |
| Class IIa |
| "1. It is reasonable that operators with acceptable volume (75 PCI procedures per year) perform elective/urgent PCI at low-volume centers (200 to 400 PCI procedures per year) with on-sitecardiac surgery.[2] (Level of Evidence: C)" |
| "2. It is reasonable that low-volume operators (75 PCI procedures per year) perform elective/urgent PCI at high-volume centers (more than 400 PCI procedures per year) with on-site cardiac surgery. Ideally, operators with an annual procedure volume of fewer than 75 procedures per year should only work at institutions with an activity level of more than 600 procedures per year. Operators who perform fewer than 75 procedures per year should develop a defined mentoring relationship with a highly experienced operator who has an annual procedural volume of at least 150 procedures. (Level of Evidence: C)" |
| Class IIb |
| "1. The benefit of primary PCI for STEMI patients eligible for fibrinolysis when performed by an operator who performs fewer than 75 procedures per year (11 PCIs for STEMI per year) is not well established. (Level of Evidence: C)" |
References
- ↑ 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 2.3 Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, Sharma S, Katz S, Clark LT, Jones RH (2005). "Volume-outcome relationships for percutaneous coronary interventions in the stent era". Circulation. 112 (8): 1171–9. doi:10.1161/CIRCULATIONAHA.104.528455. PMID 16103238. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Post PN, Kuijpers M, Ebels T, Zijlstra F (2010). "The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis". European Heart Journal. 31 (16): 1985–92. doi:10.1093/eurheartj/ehq151. PMID 20511324. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, Gore JM, Weaver WD, Rogers WJ, Tiefenbrunn AJ (2000). "Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction". JAMA :the Journal of the American Medical Association. 283 (22): 2941–7. PMID 10865271. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Canto JG, Every NR, Magid DJ, Rogers WJ, Malmgren JA, Frederick PD, French WJ, Tiefenbrunn AJ, Misra VK, Kiefe CI, Barron HV (2000). "The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators". The New England Journal of Medicine. 342 (21): 1573–80. doi:10.1056/NEJM200005253422106. PMID 10824077. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Srinivas VS, Hailpern SM, Koss E, Monrad ES, Alderman MH (2009). "Effect of physician volume on the relationship between hospital volume and mortality during primary angioplasty". Journal of the American College of Cardiology. 53 (7): 574–9. doi:10.1016/j.jacc.2008.09.056. PMID 19215830. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help) - ↑ Vakili BA, Kaplan R, Brown DL (2001). "Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in New York state". Circulation. 104 (18): 2171–6. PMID 11684626. Retrieved 2011-12-16. Unknown parameter
|month=ignored (help)