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The use of fluoroscopy to construct learning curves for coronary angiography
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
2012 (English)In: Catheterization and cardiovascular interventions, ISSN 1522-1946, E-ISSN 1522-726X, Vol. 80, no 4, 564-569 p.Article in journal (Refereed) Published
Abstract [en]


The aim of this study was to assess learning curves for coronary angiography using registry data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).


ACC and ESC guidelines for cardiologists in training recommend 200300 coronary angiographies as primary operator. Whether this is safe or sufficient to reach an adequate proficiency level is not known. The development of learning curves and factors that can determine progress is not yet clearly stated.


We extracted data from SCAAR 20052009 and identified 20 novel and 21 expert operators in coronary angiography during this observation period. Metrics possibly influenced by proficiency level were compared between the two groups. Learning curves were then identified with the expert's performance as reference defined as interquartile range (IQR).


Data from a total of 24,000 coronary angiographies were examined. Beginners used similar volumes of contrast but had longer fluoroscopy time compared with experts. Fluoroscopy time appeared to be a metric that demonstrated a clear learning curve and beginners reached experts IQR in 50 % (median) of the procedures after similar to 140 coronary angiographies. The risk of complications was independently associated with fluoroscopy time.


Fluoroscopy time seems to be the best metric to determine coronary angiography performance level and might therefore be a good proficiency measure during training. On the basis of our results we recommend the trainee to perform at least 150 coronary angiographies during supervision before proceeding with unsupervised procedures. It is not clear if the suggested number of procedures will result in decreased number of complications but the data suggests that fluoroscopy time might be a surrogate marker for complications.

Place, publisher, year, edition, pages
2012. Vol. 80, no 4, 564-569 p.
Keyword [en]
coronary angiography, learning curve, fluoroscopy time, training, proficiency level, complications
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-183551DOI: 10.1002/ccd.23298ISI: 000308929600012OAI: oai:DiVA.org:uu-183551DiVA: diva2:575067
Available from: 2012-12-07 Created: 2012-10-29 Last updated: 2012-12-12Bibliographically approved

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