title: Characterization of operator learning curve for transradial coronary interventions.
abstract: BACKGROUND
  Transradial percutaneous coronary intervention (TR-PCI) improves clinical outcomes compared to the transfemoral (TF) approach. However, inadequate training and experience has limited widespread adoption by interventional cardiologists.
  
  
  RESULTS
  Clinical and procedural characteristics for TR-PCI were prospectively collected from 1999 to 2008. To identify minimum case volume for optimum clinical benefit, single-vessel TR-PCI cases were chronologically ranked and stratified into 1 to 50, 51 to 100, 101 to 150 and 151 to 300 case volume groups for operators starting the TR approach at the study institution. Cases by operators with a >300 TR-PCI case volume comprised the control group. TR-PCI failure rates, contrast use, guide usage, and fluoroscopy time were compared among groups. A total of 1672 patients underwent TR-PCI by 28 operators. TR-PCI failure occurred in 4% and was higher in the 1 to 50 case volume group compared to the 51 to 100 (P=0.007) and control (P=0.01) groups. Contrast use was greater in the 1 to 50 group (180±79 mL) compared to the 151 to 300 (157±75 mL, P=0.02) and control (168±79 mL, P=0.05) groups. Fluoroscopy time was higher in the 1 to 50 group (15±10 minutes) compared to the 101 to 150 (13±10 minutes, P=0.04) and control (12±9 minutes, P=0.02) groups. Reasons for TR-PCI failure included spasm (38%), subclavian tortuousity (16%), poor guide support (16%), failed access (10%), and radial loop (7%). Case volume was significantly correlated with TR-PCI failure (β=-0.0076, P=0.0028), and odds of failure was reduced by 32% for each 50 increments in case volume.
  
  
  CONCLUSIONS
  TR-PCI success depends on operator experience, and a case volume of ≥50 cases is required to achieve outcomes comparable to experienced operators. These findings have implications both for PCI operators looking to expand their skills and for defining standards for training.
authors.affiliation: Terrence Donnelly Heart Center, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
authors.forename: Warren T
authors.initials: WT
authors.lastname: Ball
authors.forename: Waseem
authors.initials: W
authors.lastname: Sharieff
authors.forename: Sanjit S
authors.initials: SS
authors.lastname: Jolly
authors.forename: Tony
authors.initials: T
authors.lastname: Hong
authors.forename: Michael J B
authors.initials: MJ
authors.lastname: Kutryk
authors.forename: John J
authors.initials: JJ
authors.lastname: Graham
authors.forename: Neil P
authors.initials: NP
authors.lastname: Fam
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Chisholm
authors.forename: Asim N
authors.initials: AN
authors.lastname: Cheema
mesh_terms: D000368:Aged; D060050:Angina, Stable; D017130:Angioplasty; D017023:Coronary Angiography; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005471:Fluoroscopy; D006321:Heart / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013663:Teaching; D017211:Treatment Failure