Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators?
| Title: | Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators? |
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| Authors: | Protty MB; Sir Geraint Evans Cardiovascular Research Building, Cardiff University, Cardiff, South Glamorgan, UK.; Hasan S; Morriston Cardiac Centre, Swansea, UK.; Premawardhana D; Morriston Cardiac Centre, Swansea, UK.; Addin MS; Morriston Cardiac Centre, Swansea, UK.; Morgan H; University Hospital of Wales, Cardiff, Cardiff, UK.; King's College London, London, UK.; Bundhoo S; Grange University Hospital, Cwmbran, UK.; Hussain H; Grange University Hospital, Cwmbran, UK.; Ul-Haq Z; Morriston Cardiac Centre, Swansea, UK.; Chase A; Morriston Cardiac Centre, Swansea, UK.; Hildick-Smith D; Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.; Choudhury A; Morriston Cardiac Centre, Swansea, UK.; Kinnaird T; University Hospital of Wales, Cardiff, Cardiff, UK.; Hailan A; Morriston Cardiac Centre, Swansea, UK ahmed.hailan@wales.nhs.uk. |
| Source: | Open heart [Open Heart] 2025 Jan 30; Vol. 12 (1). Date of Electronic Publication: 2025 Jan 30. |
| Publication Type: | Journal Article; Multicenter Study |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101631219 Publication Model: Electronic Cited Medium: Print ISSN: 2053-3624 (Print) Linking ISSN: 20533624 NLM ISO Abbreviation: Open Heart Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group |
| MeSH Terms: | Percutaneous Coronary Intervention*/education ; Percutaneous Coronary Intervention*/adverse effects ; Education, Medical, Graduate*/methods ; Coronary Artery Disease*/surgery ; Clinical Competence* ; Fellowships and Scholarships*; Wales/epidemiology ; Humans ; Male ; Female ; Aged ; Retrospective Studies ; Middle Aged ; Risk Assessment ; Risk Factors ; Treatment Outcome |
| Abstract: | Background: Training in complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) has frequently been reserved for established operators (consultants/attending) with trainees (fellows-in-training or FIT) being often discouraged from carrying out such procedures as a primary operator due to their high-risk nature. Whether the outcomes of these cases differ if the primary operator is a supervised FIT compared with a consultant is unknown.; Methods: Using multicentre PCI data from three cardiac centres in South Wales, UK (2018-2022), we identified 2295 CHIP-PCI cases with a UK-BCIS CHIP Score of 3 or more. These were then divided by primary operator status (supervised FIT vs consultant); the primary outcome was in-hospital major adverse cardiac events (IH-MACCE). Multivariate logistic models were developed to adjust for differences in baseline and procedural characteristics.; Results: The primary operator in 838 (36%) of the PCIs was a supervised FIT. Baseline and procedural characteristics had lower complexity in CHIP-PCI cases carried out by supervised FIT vs consultant. In a multivariate-adjusted model, supervised FIT procedures were associated with lower odds of concurrent valve disease (OR 0.45, 95% CI: 0.29 to 0.69), dual access (OR 0.58, 95% CI: 0.41 to 0.83), cutting/scoring balloons (OR 0.59, 95% CI: 0.44 to 0.79) and rotational atherectomy (OR 0.60, 95% CI: 0.42 to 0.87). After adjusting for all variables, however, there was no difference in the primary outcome (OR 0.72, 95% 0.34 to 1.51) or any secondary outcomes. Sensitivity analyses restricted to patients with higher CHIP Scores (4+ and 5+) showed comparable IH-MACCE.; Conclusions: Training FIT as primary operators in CHIP-PCI appears to be feasible and safe and can be delivered within the standard training programme. The comparable outcomes are likely driven by the two-operator 'buddy' effect that a FIT supervised by a consultant benefits from.; (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.) |
| Competing Interests: | Competing interests: None declared. |
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| Contributed Indexing: | Keywords: Clinical Competence; Inservice Training; Percutaneous Coronary Intervention |
| Entry Date(s): | Date Created: 20250130 Date Completed: 20250130 Latest Revision: 20250627 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11784205 |
| DOI: | 10.1136/openhrt-2024-003131 |
| PMID: | 39884741 |
| Database: | MEDLINE |
Journal Article; Multicenter Study