title: Safety of percutaneous left heart catheterization directly performed by cardiology fellows: a cohort analysis.
abstract: BACKGROUND
  No previous study has analyzed the possible responsibility of fellows-in-training in terms of the risk of complications during cardiac catheterization. Thus, we sought to identify possible risk factors for access site complications following cardiac catheterization procedures, with particular attention to the role of cardiology fellows.
  
  
  METHODS
  A total of 1,288 left heart catheterization procedures (both diagnostic and interventional), performed over a 1-year period at a university hospital, were retrospectively evaluated to determine the incidence of local complications (pseudoaneurysm, arterio-venous fistula, major hematoma or bleeding, vascular dissection). Several clinical (age, gender, previous coronary artery bypass surgery, indication to the exam) and procedural (procedure performed by the fellow, access site, type of procedure, urgent setting, use of glycoprotein IIb/IIIa inhibitors, simultaneous right heart catheterization, use of closure devices) covariables were considered. Major adverse cardiovascular and cerebrovascular events (MACCE: death, myocardial infarction, cerebrovascular event) were also assessed.
  
  
  RESULTS
  The overall access site complication rate was 2.6%. On multivariate regression analysis, the only two predictors of local complications were female gender (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.6-6.5) and femoral approach (OR 3.9, 95% CI 1.2-12.1). The rate of MACCE was 1.2%, mainly after percutaneous coronary interventions, with only 1 death overall (0.07%). Procedures performed by cardiology fellows were not associated with an increased incidence of either complication.
  
  
  CONCLUSIONS
  Cardiology fellows can safely perform cardiac catheterization procedures without an increase in the rate of local and major cardiovascular complications. Of course, the presence and watchful supervision of an attending physician is still essential to ensure both patient safety and optimal training.
authors.affiliation: University of Verona, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Anselmi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gasparini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Morando
authors.forename: Paolo
authors.initials: P
authors.lastname: Tosi
authors.forename: M Luisa
authors.initials: ML
authors.lastname: De Benedictis
authors.forename: Silvia
authors.initials: S
authors.lastname: Quintarelli
authors.forename: Gionata
authors.initials: G
authors.lastname: Molinari
authors.forename: Piero
authors.initials: P
authors.lastname: Zardini
authors.forename: Marco
authors.initials: M
authors.lastname: Turri
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D002309:Cardiology / Q000193:education* / Q000592:standards*; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000592:standards; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety