Maintenance of certification in interventional cardiology requires physicians to document a minimum of 150 interventional cases over the 2 years before expiration of the current certification, complete self-assessment modules of their medical knowledge, partic- ipate in practice-based quality-improvement activities, and pass a secure, knowledge-based examination.869 871 For those who cannot meet the case volume requirement, an alternative option is to submit a log of 25 consecutive cases including patient characteristics and procedural outcomes. The mainte- nance of certification process is likely to change, as the American Board of Internal Medicine intends to evolve maintenance of certification from an episodic event that occurs once every 10 years to a more continuous process of continuous professional development. 7.4. Operator and Institutional Competency and Volume: Recommendations Class I 1. Elective/urgent PCI should be performed by opera- tors with an acceptable annual volume (>75 proce- dures) at high-volume centers (>400 procedures) with on-site cardiac surgery.872,873 (Level of Evi- dence: C) 2. Elective/urgent PCI should be performed by opera- tors and institutions whose current risk-adjusted outcomes statistics are comparable to those reported in contemporary national data registries. (Level of Evidence: C) 3. Primary PCI for STEMI should be performed by experienced operators who perform more than 75 elective PCI procedures per year and, ideally, at least 11 PCI procedures for STEMI per year. Ide- ally, these procedures should be performed in insti- tutions that perform more than 400 elective PCIs per year and more than 36 primary PCI procedures for STEMI per year.872,874 877 (Level of Evidence: C) Class IIa 1. It is reasonable that operators with acceptable vol- ume (>75 PCI procedures per year) perform elec- tive/urgent PCI at low-volume centers (200 to 400 PCI procedures per year) with on-site cardiac sur- gery.872 (Level of Evidence: C) 2. 