ArticleOpen heart2025
Complex high-risk indicated PCI (CHIP-PCI): is it safe to let fellows-in-training perform it as primary operators?
Article in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
13 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundTraining 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.
methodsUsing 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.
resultsThe 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.
conclusionsTraining 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.
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