Radial Approach Expertise and Clinical Outcomes of Percutanous Coronary Interventions Performed Using Femoral Approach

Abstract

We sought to evaluate the impact of experience and proficiency with radial approach (RA) on clinical outcomes of percutaneous coronary interventions (PCI) performed via femoral approach (FA) in the “real-world” national registry. A total of 539 invasive cardiologists performing PCIs in 151 invasive cardiology centers in Poland between 2014 and 2017 were included. Proficiency threshold was set at >300 PCIs during four consecutive years per individual operator. The majority of operators performed >75% of all PCIs via RA (449 (65.4%)), 143 (20.8%) in 50–75% of cases, 62 (9.0%) in 25–50% and only 33 (4.8%) invasive cardiologists were using RA in <25% of all PCIs. Operators with the highest proficiency in RA were associated with increased risk of periprocedural death, stroke and bleeding complications at access site during angiography via FA. Similarly, higher prevalence of periprocedural mortality during PCI with FA was observed in most experienced radial operators as compared to other groups. The detrimental effect of FA utilization by the most experienced radial operators was observed in both stable angina and acute coronary syndromes. Higher experience and utilization of RA might be linked to worse outcomes of PCIs performed via femoral artery in both stable and acute settings.

Radial approach reduces mortality in ST-segment elevation myocardial infarction with cardiogenic shock

“…Despite the wide range of proficiency of invasive cardiologists, both FA and RA used by trained and experienced cardiologists were linked to reduced mortality. This observation is consistent with previously reported data [5,33]. Procedures performed by the most experienced operators in RA might be associated with higher mortality in PCI with FA utilization.…”

“…Procedures performed by the most experienced operators in RA might be associated with higher mortality in PCI with FA utilization. This observation seems to be related to a decreased dexterity level in FA in favor of RA adaptation in everyday clinical practice [5,33]. Thus, the impact of proficiency and experience might be another plausible elucidation for a favorable outcome in the RA group.…”

“…A complete description and design of the ORPKI national registry were reported in previous studies [3,5,[13][14][15]. In brief, the ORPKI is an electronic database accumulating all PCI procedures in interventional cardiology in Poland.…”

“…Radial approach (RA) has been widely adopted in percutaneous coronary interventions (PCIs) [1][2][3][4][5][6]. A growing body of evidence demonstrated the advantage of the RA over the femoral approach (FA) in PCI for ST-segment elevation myocardial infarction (STEMI) [1][2][3][4][5][6][7][8].…”

Interventional cardiology in Poland in 2019. Summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and Jagiellonian University Medical College*

“…The database is endorsed by Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and is operated by the Jagiellonian University Medical College, with currently 153 interventional cardiology centers in Poland reporting daily. The ORPKI database analysis of various trends and patterns is published each year [3][4][5]. On 31 st of December 2019 there were 541 percutaneous coronary intervention (PCI) operators and 32 diagnosticians certified by AISN PTK in Poland.…”