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Development and construct validation of performance metrics for multivessel coronary interventions on the VIST virtual reality simulator at PCR2005.

BACKGROUND
The first aim of this study was the development of performance metrics in a virtual reality simulation for interventional procedure in a real case of multivessel coronary disease. A second aim was to assess the construct validity of these metrics by comparing the performance of interventional cardiologists with different levels of experience.


METHODS
Ninety-four practicing interventional cardiologists attending the EuroPCR 2005 in Paris, France participated in this study. Complete data was available on eighty-nine participants (95%). Participants were divided into three categories depending on experience. Group 1 (novices): N = 33, < 1 years experience; Group 2 (intermediate experience): N = 14, >50 cases per year for the last two years and Group 3 (master physicians): N = 42 participants completed > 100 cases per year during the last five years.


PROCEDURE
Over a period of months during 2004-2005 we identified potential performance metrics for cases of coronary artery disease which were then applied to a case of a patient admitted because of stable angina (class 1) with multivessel coronary disease. Patient's coronary anatomy and lesions were then reconstructed and implemented for the VIST virtual reality simulator. All participants were required to perform this case.


RESULTS
Overall, experienced interventional cardiologists performed significantly better than the novices for traditional metrics such as time (p = 0.03), contrast fluid (p = 0.0008) and Fluroscopy time (p = 0.005). Master physicians performed significantly better than the other two groups on metrics which assessed technical performance e.g., time to ascend the aorta (p = 0.0004) and stent placement accuracy (p = 0.02). Furthermore, master physicians made fewer handling errors than the intermediated group who in turn made fewer than the novice group (p = 0.0003). Performance consistency was also a linear function of experience.


CONCLUSIONS
Novel performance metrics developed for the assessment of technical skills for a simulated intervention for multi-vessel coronary disease showed that more experienced interventional cardiologists performed the procedure better than less experienced interventionalists thus demonstrating construct validity of the metrics.