Learning Curve for Transradial and Transfemoral Coronary Angiography amongst Cardiology Trainees

Abstract

A decrement in fluoroscopy time (FT) is one objective measure of competency in coronary angiography. Aims:To establish if a difference in FT exists between consultants and trainees, investigate if trainees have shorter FT with increasing seniority, compare transradial (TR) and transfemoral (TF) FTs of trainees, and determine a minimum number of TR cases to overcome the potential "learning curve". Methods and results:The total, TF and TR FTs in patients was assessed over four years. Cases were dichotomized to with trainee (trainee) or without trainee (consultant) present in the catherization laboratory. Complex cases were excluded. 1699 patients underwent diagnostic coronary angiography during the study period, where the trainee was present in 707 cases. Patients in the trainee cohort were older, but there was no other significant difference in demographics. The presence of a trainee resulted in longer FTs (6.0 versus 3.9 min, p<0.001). The median FT of trainees improved between their first and second fifty cases (6.5 mins vs 5.2 mins, p-value<0.0001). After the first 50 TR cases, median trainee TR FT fell within the IQR of consultants. Conclusion:Cardiology trainees have longer total, TF and TR fluoroscopy times compared to consultant cardiologists. However, these times improved with increasing experience.