Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results?

Gargiulo, Giuseppe; Heg, Dik; Ferrari, Fabrizio; Percoco, Gianfranco; Campo, Gianluca; Tumscitz, Carlo; Colombo, Federico; Zuffi, Andrea; Castriota, Fausto; Cremonesi, Alberto; Windecker, Stephan; Valgimigli, Marco (2017). Stent and Dual Antiplatelet Therapy Duration Comparisons in the Setting of a Multicenter Randomized Controlled Trial: Can the Operator Experience Affect the Study Results? Journal of the American Heart Association, 6(12), e007150. American Heart Association 10.1161/JAHA.117.007150

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BACKGROUND Operator experience influences outcomes after percutaneous coronary intervention, but this association in the controlled setting of a randomized, clinical trial is unclear. METHODS AND RESULTS We investigated operator-related outcomes (30-day and 2-year efficacy and safety end points) among patients undergoing percutaneous coronary intervention and randomized to different dual antiplatelet therapy durations and stent types. A total of 2003 patients were analyzed, and 7 operator groups were compared. The majority of preprocedural and postprocedural characteristics were imbalanced. The primary end point of the study, the composite of death, myocardial infarction, or cerebrovascular accidents, did not differ among operators at 30 days or 2 years. There were no significant differences also for all other individual and composite end points analyzed at 30 days and 2 years, except for 2-year stent thrombosis (P=0.048) and bleeding events (P=0.022 for Bleeding Academic Research Consortium type 2, 3, or 5). Adjusted comparisons for the main end points showed slight differences among operators at 30 days, but not at 2 years. There was no interaction of operator with dual antiplatelet therapy duration (P=0.112) or stent type (P=0.300). Results remained entirely consistent when operators were stratified by their experience. CONCLUSIONS There was a weak signal of heterogeneity across study operators for the 30-day, but not the 2-year, main study outcomes. No clear effect of operator or operator experience was observed for the comparative efficacy and safety profile of the randomized stent types or dual antiplatelet therapy duration regimens. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00611286.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Gargiulo, Giuseppe; Heg, Dierik Hans; Windecker, Stephan and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2047-9980

Publisher:

American Heart Association

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

15 Feb 2018 10:48

Last Modified:

26 Feb 2018 11:01

Publisher DOI:

10.1161/JAHA.117.007150

PubMed ID:

29275371

Uncontrolled Keywords:

clinical outcomes operator percutaneous coronary intervention randomized trial

BORIS DOI:

10.7892/boris.110651

URI:

https://boris.unibe.ch/id/eprint/110651

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