Attempts to understand the relationship between procedural volumes and percutaneous coronary intervention (PCI) outcomes has been a focus since the early days of angioplasty . Subsequent analyses performed through the years demonstrated that higher procedural volumes by operators and hospital systems were associated with lower mortality. These observations led to procedural volume becoming an important quality metric when evaluating physician operators and PCI centers . Although procedural volume is easily obtainable and, therefore, a convenient metric for policy implementation, paradigm-shifting improvements in procedural techniques and technologies over time have narrowed the differences in outcomes previously separating low- and high-volume centers , thereby leading to questions of whether procedural volume remains a relevant quality metric in contemporary practice .