JACC. Cardiovascular interventions · 2014
Experience and outcomes with carotid artery stenting: an analysis of the CHOICE study (Carotid Stenting for High Surgical-Risk Patients; Evaluating Outcomes Through the Collection of Clinical Evidence).
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Shishehbor Mehdi H, Venkatachalam Sridhar, Gray William A, Metzger Christopher, Lal Brajesh K, Peng Lei, Omran Hend L, Blackstone Eugene H
Аннотация
OBJECTIVES: This study sought to examine operator experience measured by time-related variables on outcomes with protected carotid artery stenting (CAS).
BACKGROUND: Studies on experience have focused on operator and institutional CAS volumes alone in the absence of a better metric.
METHODS: Using the CHOICE (Carotid Stenting for High Surgical-Risk Patients; Evaluating Outcomes Through the Collection of Clinical Evidence) multicenter prospective data from October 1, 2006 to June 1, 2012, 5,841 evaluable subjects were identified. Operator experience within this study was assessed using 5 variables for each operator: 1) baseline CAS volume; 2) time from first CAS to each subsequent CAS; 3) time between each CAS; 4) CAS volume in the institution; and 5) medical specialty (cardiology, surgery, or radiology/neurology). Institutional experience was determined by CAS volume within the study. Embolic protection device dwell time was used to assess technical performance, and 30-day death, stroke, or myocardial infarction composed the clinical outcome. Hierarchical logistic regression and linear mixed models were used.
RESULTS: Cardiologists (p < 0.001) along with operators with longer time interval from first CAS (p < 0.001) had reduced embolic protection device dwell times (technical performance). Increased time interval between CAS was the only independent predictor of 30-day death, stroke, or myocardial infarction (adjusted odds ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.005). Prolonged embolic protection device dwell time was associated with 30-day death, stroke, or myocardial infarction (adjusted odds ratio: 1.08; 95% confidence interval: 1.01 to 1.17; p = 0.03).
CONCLUSIONS: The time interval between CAS procedures, specialty assignment, and time from first CAS are important measures of operator experience that may significantly affect technical performance and clinical outcome.
BACKGROUND: Studies on experience have focused on operator and institutional CAS volumes alone in the absence of a better metric.
METHODS: Using the CHOICE (Carotid Stenting for High Surgical-Risk Patients; Evaluating Outcomes Through the Collection of Clinical Evidence) multicenter prospective data from October 1, 2006 to June 1, 2012, 5,841 evaluable subjects were identified. Operator experience within this study was assessed using 5 variables for each operator: 1) baseline CAS volume; 2) time from first CAS to each subsequent CAS; 3) time between each CAS; 4) CAS volume in the institution; and 5) medical specialty (cardiology, surgery, or radiology/neurology). Institutional experience was determined by CAS volume within the study. Embolic protection device dwell time was used to assess technical performance, and 30-day death, stroke, or myocardial infarction composed the clinical outcome. Hierarchical logistic regression and linear mixed models were used.
RESULTS: Cardiologists (p < 0.001) along with operators with longer time interval from first CAS (p < 0.001) had reduced embolic protection device dwell times (technical performance). Increased time interval between CAS was the only independent predictor of 30-day death, stroke, or myocardial infarction (adjusted odds ratio: 1.05, 95% confidence interval: 1.02 to 1.09, p = 0.005). Prolonged embolic protection device dwell time was associated with 30-day death, stroke, or myocardial infarction (adjusted odds ratio: 1.08; 95% confidence interval: 1.01 to 1.17; p = 0.03).
CONCLUSIONS: The time interval between CAS procedures, specialty assignment, and time from first CAS are important measures of operator experience that may significantly affect technical performance and clinical outcome.
Предметные рубрики MeSH
AgedAged, 80 and overAngioplastyClinical CompetenceCoronary Artery DiseaseEmbolic Protection DevicesFemaleHospitals, High-VolumeHospitals, Low-VolumeHumansLinear ModelsLogistic ModelsMaleMiddle AgedMyocardial InfarctionOdds RatioPatient SelectionProduct Surveillance, PostmarketingProspective StudiesQuality Indicators, Health CareRisk AssessmentRisk FactorsSpecializationStentsStrokeTask Performance and AnalysisTime FactorsTreatment OutcomeUnited States