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Case Volumes and Outcomes Among Early-Career Interventional Cardiologists in the United States.

Publication ,  Journal Article
Rymer, JA; Narcisse, DI; Chen, A; Wojdyla, D; Ashley, S; Damluji, AA; Shah, B; Nanna, MG; Swaminathan, R; Gutierrez, JA; Uzendu, A; Nelson, AJ ...
Published in: J Am Coll Cardiol
May 21, 2024

BACKGROUND: Little is known about the procedural characteristics, case volumes, and mortality rates for early- vs non-early-career interventional cardiologists in the United States. OBJECTIVES: This study examined operator-level data for patients who underwent percutaneous coronary intervention (PCI) between April 2018 and June 2022. METHODS: Data were collected from the National Cardiovascular Data Registry CathPCI Registry, American Board of Internal Medicine certification database, and National Plan and Provider Enumeration System database. Early-career operators were within 5 years of the end of training. Annual case volume, expected mortality and bleeding risk, and observed/predicted mortality and bleeding outcomes were evaluated. RESULTS: A total of 1,451 operators were early career; 1,011 changed their career status during the study; and 6,251 were non-early career. Overall, 514,540 patients were treated by early-career and 2,296,576 patients by non-early-career operators. The median annual case volume per operator was 59 (Q1-Q3: 31-97) for early-career and 57 (Q1-Q3: 28-100) for non-early-career operators. Early-career operators were more likely to treat patients presenting with ST-segment elevation myocardial infarction and urgent indications for PCI (both P < 0.001). The median predicted mortality risk was 2.0% (Q1-Q3: 1.5%-2.7%) for early-career and 1.8% (Q1-Q3: 1.2%-2.4%) for non-early-career operators. The median predicted bleeding risk was 4.9% (Q1-Q3: 4.2%-5.7%) for early-career and 4.4% (Q1-Q3: 3.7%-5.3%) for non-early-career operators. After adjustment, an increased risk of mortality (OR: 1.08; 95% CI: 1.05-1.17; P < 0.0001) and bleeding (OR: 1.08; 95% CI: 1.05-1.12; P < 0.0001) were associated with early-career status. CONCLUSIONS: Early-career operators are caring for patients with more acute presentations and higher predicted risk of mortality and bleeding compared with more experienced colleagues, with modestly worse outcomes. These data should inform institutional practices to support the development of early-career proceduralists.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 21, 2024

Volume

83

Issue

20

Start / End Page

1990 / 1998

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male
  • Humans
  • Female
  • Clinical Competence
  • Cardiovascular System & Hematology
  • Cardiologists
 

Citation

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Chicago
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Rymer, J. A., Narcisse, D. I., Chen, A., Wojdyla, D., Ashley, S., Damluji, A. A., … Doll, J. A. (2024). Case Volumes and Outcomes Among Early-Career Interventional Cardiologists in the United States. J Am Coll Cardiol, 83(20), 1990–1998. https://doi.org/10.1016/j.jacc.2024.03.395
Rymer, Jennifer A., Dennis I. Narcisse, Angel Chen, Daniel Wojdyla, Sarah Ashley, Abdulla A. Damluji, Binita Shah, et al. “Case Volumes and Outcomes Among Early-Career Interventional Cardiologists in the United States.J Am Coll Cardiol 83, no. 20 (May 21, 2024): 1990–98. https://doi.org/10.1016/j.jacc.2024.03.395.
Rymer JA, Narcisse DI, Chen A, Wojdyla D, Ashley S, Damluji AA, et al. Case Volumes and Outcomes Among Early-Career Interventional Cardiologists in the United States. J Am Coll Cardiol. 2024 May 21;83(20):1990–8.
Rymer, Jennifer A., et al. “Case Volumes and Outcomes Among Early-Career Interventional Cardiologists in the United States.J Am Coll Cardiol, vol. 83, no. 20, May 2024, pp. 1990–98. Pubmed, doi:10.1016/j.jacc.2024.03.395.
Rymer JA, Narcisse DI, Chen A, Wojdyla D, Ashley S, Damluji AA, Shah B, Nanna MG, Swaminathan R, Gutierrez JA, Uzendu A, Nelson AJ, Bethel G, Kearney K, Jones WS, Rao SV, Doll JA. Case Volumes and Outcomes Among Early-Career Interventional Cardiologists in the United States. J Am Coll Cardiol. 2024 May 21;83(20):1990–1998.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 21, 2024

Volume

83

Issue

20

Start / End Page

1990 / 1998

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Percutaneous Coronary Intervention
  • Middle Aged
  • Male
  • Humans
  • Female
  • Clinical Competence
  • Cardiovascular System & Hematology
  • Cardiologists