Long-term outcomes and operators' experience in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

IF 3.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Intervention and Therapeutics Pub Date : 2024-10-27 DOI:10.1007/s12928-024-01059-5
Kei Takamizawa, Masaomi Gohbara, Yohei Hanajima, Katsuhiko Tsutsumi, Hidekuni Kirigaya, Jin Kirigaya, Hidefumi Nakahashi, Yugo Minamimoto, Yuichiro Kimura, Noriyuki Kawaura, Kensuke Matsushita, Kozo Okada, Masaaki Konishi, Noriaki Iwahashi, Masami Kosuge, Teruyasu Sugano, Toshiaki Ebina, Kiyoshi Hibi
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Abstract

Primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) is typically performed by experienced operators. Therefore, the safety of pPCI for STEMI performed by less experienced operators with the support of experienced operators remains unknown. We aimed to investigate the long-term outcomes of pPCI for STEMI performed by less experienced operators with the support of experienced operators. In total, 775 STEMI patients were enrolled and divided into groups according to operator experience in PCI: less experienced (n = 384) and experienced (n = 391) operator groups. Experienced operators were defined as those who had performed > 50 elective PCI procedures per year as the first operator or instructional assistant, whereas less experienced operators were defined as others. When less experienced operators performed the pPCI, experienced operators supported them. The primary endpoint was any cardiovascular event, defined as a composite of cardiovascular death, nonfatal myocardial infarction, and unplanned hospitalization for heart failure. In the propensity score-matched analysis, 324 patients were included in each group. The cumulative incidence of the primary endpoint over a median of 5 years in the less experienced operator group was similar to that in the experienced operator group (15% vs. 18%, P = 0.209). In the multivariate Cox proportional hazards model, there was no excess risk for patients operated upon by less experienced operators for the primary endpoint (adjusted hazard ratio, 0.85; 95% confidence interval, 0.58-1.25; P = 0.417). pPCI for STEMI by less experienced operators did not increase the risk of in-hospital mortality or 5-year long-term cardiovascular events if supported by experienced operators.

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经皮冠状动脉介入治疗 ST 段抬高型心肌梗死的长期疗效和操作者的经验。
ST 段抬高型心肌梗死(STEMI)的原发性经皮冠状动脉介入治疗(pPCI)通常由经验丰富的操作人员实施。因此,由经验较少的操作者在经验丰富的操作者的支持下进行 STEMI pPCI 的安全性仍是未知数。我们的目的是研究由经验较少的操作人员在经验丰富的操作人员的支持下进行 STEMI pPCI 的长期疗效。我们共招募了 775 名 STEMI 患者,并根据操作者在 PCI 方面的经验将其分为两组:经验较少的操作者组(n = 384)和经验丰富的操作者组(n = 391)。经验丰富的操作者被定义为每年作为第一操作者或指导助手实施过 50 例以上择期 PCI 手术的操作者,而经验较少的操作者被定义为其他操作者。当经验不足的操作者进行 pPCI 时,经验丰富的操作者为其提供支持。主要终点是任何心血管事件,定义为心血管死亡、非致命性心肌梗死和非计划性心衰住院的综合。在倾向评分匹配分析中,每组纳入了 324 名患者。经验较少的操作者组与经验丰富的操作者组在中位 5 年的主要终点累积发生率相似(15% 对 18%,P = 0.209)。在多变量 Cox 比例危险模型中,由经验较少的操作者进行手术的患者在主要终点方面没有过高的风险(调整后危险比为 0.85;95% 置信区间为 0.58-1.25;P = 0.417)。由经验较少的操作者进行 STEMI pPCI 并不会增加院内死亡率或 5 年长期心血管事件的风险,如果由经验丰富的操作者进行支持的话。
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来源期刊
Cardiovascular Intervention and Therapeutics
Cardiovascular Intervention and Therapeutics CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.30
自引率
12.50%
发文量
68
期刊介绍: Cardiovascular Intervention and Therapeutics (CVIT) is an international journal covering the field of cardiovascular disease and includes cardiac (coronary and noncoronary) and peripheral interventions and therapeutics. Articles are subject to peer review and complete editorial evaluation prior to any decision regarding acceptability. CVIT is an official journal of The Japanese Association of Cardiovascular Intervention and Therapeutics.
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