Operator learning curve for transradial percutaneous coronary interventions: implications for the initiation of a transradial access program in contemporary US practice |
| |
| Affiliation: | 1. Department of Cardiology, Shaare Zedek Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel;2. Neufeld Cardiac Research Institute, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Department of Cardiology, Beilinson Campus, Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;4. Department of Cardiology, Hadassah Medical Center, The Hebrew University Hadassah Medical School, Jerusalem, Israel;1. Instituto Multidisciplinario sobre Ecosistemas y Desarrollo Sustentable. Facultad de Ciencias Exactas, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina;2. Laboratorio de Ecología y Comportamiento Animal, Departamento de Ecología, Genética y Evolución, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina;1. South-Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, NSW, Australia;2. Liverpool Hospital, Sydney, NSW, Australia;3. Western Sydney University, Liverpool Hospital, Sydney, NSW, Australia;1. Department of Comparative Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA;2. Penn State Hershey Pediatric Cardiovascular Research Center, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA;3. Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA |
| |
| Abstract: | ObjectivesOur study aimed to assess the characteristics and outcomes of transfemoral approach (TFA) versus the initial steps of a transradial approach (TRA) program and to assess the learning curve of TRA in contemporary, US practice.BackgroundWhen compared to TFA, TRA has been shown to lower bleeding and vascular complications during percutaneous coronary intervention (PCI). However, use of TRA is still low. There are limited data regarding the characteristics of TRA learning curve, especially in an era with designated TRA equipment.MethodsConsecutive patients undergoing PCI in a single US center were divided into two cohorts according to vascular access approach: the last 250 TFA patients prior to the establishment of a TRA program and the initial 239 TRA patients following the establishment of a TRA program. Subgroup analysis of the TRA group, which was divided into five sequential case groups of 50 cases per group, was performed in order to assess TRA learning curve.ResultsOverall, the baseline characteristics of TFA vs. TRA groups were comparable. Fluoroscopy time was significantly longer during TRA procedures (18 ± 11 vs. 15 ± 8 min, respectively, p = 0.002); however, contrast use was lower during TRA procedures (161 ± 72 vs. 180 ± 63 ml, respectively, p = 0.002). In-hospital outcomes were similar between the two groups, with low frequencies of mortality, myocardial infarction, and stent thrombosis. Subanalysis of TRA group for learning curve assessment showed no major differences in patient demographics among the five subgroups. In the initial cases, more PCI was performed among non-acute cases (62% in patients 1–50 vs. 8–27% in patients 51–239, p < 0.001). Despite these differences, characteristics of the treated vessels were similar between groups. There was no significant change in fluoroscopy time or in the amount of iodinated contrast volume delivered. Similarly, no differences in procedural, in-hospital, and long-term outcomes were documented.ConclusionsAdopting TRA as a default is feasible for high-volume operators without significant learning curve effects. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
