Operator volume and mortality in percutaneous coronary intervention: a call for better competency metrics

In manual disciplines, increasing levels of practice are expected to parallel the individual’s ability to perform a specific action or technique. In the field of interventional cardiology, a skilled operator is able to optimize all the steps of percutaneous coronary intervention (PCI), from vascular access to stent implantation, while reducing the total amount of contrast dye administered and procedural time. On top of sound clinical judgment, these factors may translate into a better prognosis. Improved outcomes with proficient operators are even more obvious in complex anatomical (e.g. left main disease or chronic total occlusions) and clinical (e.g. primary PCI or cardiogenic shock) settings, or at the time of managing procedural complications (e.g. perforations, dissections, or bleeding)