Change in Hospital-Level Use of Transradial Percutaneous Coronary Intervention and Periprocedural Outcomes

Abstract

Background Whether increasing use of radial access has improved percutaneous coronary intervention outcomes remains unknown. We sought to determine the relationship between increasing facility-level use of transradial percutaneous coronary intervention (TRI) and periprocedural outcomes. Methods and Results Within the National Cardiovascular Data Registry CathPCI Registry, we estimated the risk-adjusted association between hospital category of change in TRI use (during the 3-year period from 2009 to 2012) and trends in access site and overall bleeding, fluoroscopy time, and contrast use among 818 facilities with low baseline TRI use. There were 4 categories of hospital change in TRI use: very low (baseline, 0.2% increasing to 1.8% at the end of 3 years), low (0.9% increasing to 8.9%), moderate (1.6% increasing to 27.2%), and high (1.0% increasing to 45.1%). Risk-adjusted access site bleeding decreased over time for all hospital categories; however, the rate of decline varied across hospital categories (P for interaction, <0.001). The decrease in access site bleeding was significantly greater for hospitals with moderate or high increases in TRI use (relative risk, 0.45, 95% confidence interval, 0.36–0.56) when compared with that of very low or low hospitals (relative risk, 0.65; 95% confidence interval, 0.58–0.74; P for comparison, 0.002). Similar findings were observed for overall bleeding. An increase in fluoroscopy time (≈1.3 minutes) was noted at hospitals with moderate and high use of TRI (P=0.01). Trends in contrast use were similar across hospital categories. Conclusions In a national sample of hospitals performing percutaneous coronary intervention, bleeding rates decreased over time for all hospital categories of change in TRI use. The decline in bleeding outcomes was larger at hospitals with increased adoption of TRI when compared with hospitals with minimal or no change in TRI use.

Appropriate Use Criteria for Coronary Revascularization and Trends in Utilization, Patient Selection, and Appropriateness of Percutaneous Coronary Intervention

“…15,16 Latent class growth curve analysis, employing growth mixture modeling, serves to identify distinct patterns of change over time using each hospital’s observed trajectory of the proportion of non-acute PCIs classified as inappropriate. Hospitals with similar patterns over time are grouped together and considered to form a latent class.…”

Underutilization of Radial Access in Patients Undergoing Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction

“…When stratifying centers by rates of TRA adoption, however, the decline in bleeding outcomes was significantly larger at hospitals with more rapid adoption of TRA than with those with little or no change in TRA utilization. 25 Superior outcomes, including lower rates of bleeding and at times improved in-hospital mortality, have been widely reported for TRA than for TFA in primary PCI for STEMI and include multiple randomized trials, 4,11,13 several recent meta-analyses, 12,[26][27][28] and a large volume of observational data. 1,14,29,30 The majority of randomized data showing clinical benefit from TRA PCI have been from high-volume, experienced providers.…”

The wise radialist's guide to optimal transfemoral access: Selection, performance, and troubleshooting

“…If one accepts that operator experience and volume is a determinant of procedural outcomes , the widespread adoption of TRA might have had unintended consequences on the outcomes and performance of TFA . Data from single‐center and large national registries recently hinted at a paradoxical increase in the rates of femoral VASC that is proportional to the relative volume of TRA . This increase might be associated with a higher prevalence of patient‐ and procedure‐related VASC risk factors in TFA cases , but also with a loss of skills to safely perform TFA.…”