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Success of transradial PCI dependent on operator experience
Ball W. Circ Cardiovasc Interv. 2011;4:336-341.
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Operators with a higher caseload of transradial percutaneous coronary interventions had a significantly higher likelihood of procedural success, researchers reported.
“Transradial (TR) PCI has been shown to decrease vascular complications, promote early ambulation, shorten hospital stay, lower health care costs and improve clinical outcomes compared with a transfemoral approach,” they wrote. “Despite the demonstrated benefits, TR-PCI has not gained widespread use by interventional cardiologists. … Technical challenges and inadequate training with the potential for lower procedural success and greater contrast and radiation exposure are likely responsible for the underuse of TR-PCI.”
This led the group of Canada-based researchers to investigate the learning curve associated with TR-PCI and the relationship between procedural volume and success rate.
The study included 1,672 PCI procedures utilizing the TR approach performed between 1999 and 2008. Operators performing TR-PCI were stratified based upon caseload: one to 50 cases (n=655); 51 to 100 cases (n=344); 101 to 150 cases (n=213); and 151 to 300 cases (n=141). The control group for the study were operators who had more than 300 TR-PCI cases (n=319).
TR-PCI failure, defined as the inability to complete the PCI procedure by radial approach, was documented in 4% of all procedures, with the rate significantly higher in the one to 50 case arm vs. the 51 to 100 arm (P=.007) and the control group (P=.01). Additionally, contrast use was also higher in the lowest caseload arm vs. 151 to 300 (P=.02) and control (P=.05) groups, as was fluoroscopy time compared with the 101 to 150 (P=.04) and control (P=.02) groups.
Overall, case volume was significantly associated with TR-PCI failure (P=.0028), with the likelihood of failure reducing by 32% with each 50 increments in case volume.
“These findings suggest that benefits offered by transradial PCI can be realized by low- to intermediate-volume operators without added procedural complexity or risk and have important implications both for PCI operators looking to expand their skills and for defining standards for training,” the researchers concluded.
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