title: Trained and supervised physician assistants can safely perform diagnostic cardiac catheterization with coronary angiography.
abstract: Using a prospectively collected database of patients undergoing cardiac catheterization, we sought to compare the outcomes of procedures performed by supervised physician assistants (PAs) with those performed by supervised cardiology fellows-in-training. Outcome measures included procedural length, fluoroscopy use, volume of contrast media, and complications including myocardial infarction, stroke, arrhythmia requiring defibrillation or pacemaker placement, pulmonary edema requiring intubation, and vascular complications. Class 3 and 4 congestive heart failure was more common in patients who underwent procedures by fellows compared with those undergoing procedures by PAs (P = 0.001). PA cases tended to be slightly faster (P = 0.05) with less fluoroscopic time (P < 0.001). The incidence of major complications within 24 hr of the procedure was similar between the two groups (0.54% in PA cases and 0.58% in fellow cases). Under the supervision of experienced attending cardiologists, trained PAs can perform diagnostic cardiac catheterization, including coronary angiography, with complication rates similar to those of cardiology fellows-in-training.
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: Carole
authors.initials: C
authors.lastname: Ross
authors.forename: John F
authors.initials: JF
authors.lastname: Bolles
authors.forename: Erica L
authors.initials: EL
authors.lastname: Moloney
authors.forename: Larry P
authors.initials: LP
authors.lastname: Kelly
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Bashore
authors.forename: Michael H
authors.initials: MH
authors.lastname: Sketch
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002309:Cardiology / Q000193:education* / Q000706:statistics & numerical data; D003287:Contrast Media; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003404:Creatinine / Q000097:blood; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007318:Inservice Training / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009934:Organization and Administration / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000193:education* / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine