Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators?
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 d...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-01-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003131.full |
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| author | Tim Kinnaird Zia Ul-Haq Holly Morgan Anirban Choudhury Majd B Protty Alexander Chase David Hildick-Smith Shantu Bundhoo Saad Hasan Diluka Premawardhana Ahmed Hailan Mohammed Shugaa Addin Hussain Hussain |
| author_facet | Tim Kinnaird Zia Ul-Haq Holly Morgan Anirban Choudhury Majd B Protty Alexander Chase David Hildick-Smith Shantu Bundhoo Saad Hasan Diluka Premawardhana Ahmed Hailan Mohammed Shugaa Addin Hussain Hussain |
| author_sort | Tim Kinnaird |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-1ef6726cc166498ca54522e8d7f241fa |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-1ef6726cc166498ca54522e8d7f241fa2025-01-31T22:35:09ZengBMJ Publishing GroupOpen Heart2053-36242025-01-0112110.1136/openhrt-2024-003131Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators?Tim Kinnaird0Zia Ul-Haq1Holly Morgan2Anirban Choudhury3Majd B Protty4Alexander Chase5David Hildick-Smith6Shantu Bundhoo7Saad Hasan8Diluka Premawardhana9Ahmed Hailan10Mohammed Shugaa Addin11Hussain Hussain12University Hospital of Wales, Cardiff, Cardiff, UKMorriston Cardiac Centre, Swansea, UKUniversity Hospital of Wales, Cardiff, Cardiff, UKMorriston Cardiac Centre, Swansea, UKSir Geraint Evans Cardiovascular Research Building, Cardiff University, Cardiff, South Glamorgan, UKMorriston Cardiac Centre, Swansea, UKSussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UKGrange University Hospital, Cwmbran, UKMorriston Cardiac Centre, Swansea, UKMorriston Cardiac Centre, Swansea, UKMorriston Cardiac Centre, Swansea, UKMorriston Cardiac Centre, Swansea, UKGrange University Hospital, Cwmbran, UKBackground 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.https://openheart.bmj.com/content/12/1/e003131.full |
| spellingShingle | Tim Kinnaird Zia Ul-Haq Holly Morgan Anirban Choudhury Majd B Protty Alexander Chase David Hildick-Smith Shantu Bundhoo Saad Hasan Diluka Premawardhana Ahmed Hailan Mohammed Shugaa Addin Hussain Hussain Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators? Open Heart |
| title | Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators? |
| title_full | Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators? |
| title_fullStr | Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators? |
| title_full_unstemmed | Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators? |
| title_short | Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators? |
| title_sort | complex high risk indicated pci chip pci is it safe to let fellows in training perform it as primary operators |
| url | https://openheart.bmj.com/content/12/1/e003131.full |
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