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Coronary artery disease
Original research article
Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions
  1. Vinoda Sharma1,
  2. S T Jadhav1,
  3. A A Harcombe1,
  4. P A Kelly2,
  5. A Mozid2,
  6. A Bagnall3,
  7. J Richardson3,
  8. M Egred3,
  9. M McEntegart4,
  10. A Shaukat4,
  11. K Oldroyd4,
  12. G Vishwanathan5,
  13. O Rana5,
  14. S Talwar5,
  15. M McPherson6,
  16. J W Strange7,
  17. C G Hanratty8,
  18. S J Walsh8,
  19. J C Spratt6 and
  20. W H T Smith1
  1. 1Trent Cardiac Centre, Nottingham City Hospital, Nottingham, UK
  2. 2The Essex Cardiothoracic Centre, Essex, UK
  3. 3Freeman Hospital, Newcastle upon Tyne, UK
  4. 4Golden Jubilee National Hospital, Clydebank, UK
  5. 5Royal Bournemouth Hospital, Bournemouth, UK
  6. 6Forth Valley Royal Hospital, Larbert, UK
  7. 7Bristol Royal Infirmary, Bristol, UK
  8. 8Belfast City Hospital, Belfast, UK
  1. Correspondence to Dr WHT Smith; William.Smith{at}nuh.nhs.uk

Abstract

Objective To assess the impact of proctoring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in six UK centres.

Methods We retrospectively analysed 587 CTO procedures from six UK centres and compared success rates of operators who had received proctorship with success rates of the same operators before proctorship (pre-proctored) and operators in the same institutions who had not been proctored (non-proctored). There were 232 patients in the pre-proctored/non-proctored group and 355 patients in the post-proctored group. Complexity was assessed by calculating the Japanese CTO (JCTO) score for each case.

Results CTO PCI success was greater in the post-proctored compared with the pre-proctored/non-proctored group (77.5% vs 62.1%, p<0.0001). In more complex cases where JCTO≥2, the difference in success was greater (70.7% vs 49.5%, p=0.0003). After proctoring, there was an increase in CTO PCI activity in centres from 2.5% to 3.5%, p<0.0001 (as a proportion of total PCI), and the proportion of very difficult cases with JCTO score ≥3 increased from 15.3% (35/229) to 29.7% (105/354), p<0.0001.

Conclusions Proctoring resulted in an increase in procedural success for CTO PCI, an increase in complex CTO PCI and an increase in total CTO PCI activity. Proctoring may be a valuable way to improve access to CTO PCI and the likelihood of procedural success.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2014-000228

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