title: Comparison of percutaneous coronary intervention safety before and during the establishment of a transradial program at a teaching hospital.
abstract: This study sought to examine the safety of percutaneous coronary intervention (PCI) before and during de novo establishment of a transradial (TR) program at a teaching hospital. TR access remains underused in the United States, where cardiology fellowship programs continue to produce cardiologists with little TR experience. Establishment of TR programs at teaching hospitals may affect PCI safety. Starting in July 2009 a TR program was established at a teaching hospital. PCI-related data for academic years 2008 to 2009 (Y1) and 2009 to 2010 (Y2) were prospectively collected and retrospectively analyzed. Of 1,366 PCIs performed over 2 years, 0.1% in Y1 and 28.7% in Y2 were performed by TR access. No major complications were identified in 194 consecutive patients undergoing TR PCI, and combined bleeding and vascular complication rates were lower in Y2 versus Y1 (0.7% vs 2.0%, p = 0.05). Patients treated in Y2 versus Y1 and by TR versus transfemoral approach required slightly more fluoroscopy but similar contrast volumes and had similar procedural durations, lengths of stay, and predischarge mortality rates. PCI success rates were 97% in Y1, 97% in Y2, and 98% in TR cases. TR PCIs were performed by 13 cardiology fellows and 9 attending physicians, none of whom routinely performed TR PCI previously. In conclusion, de novo establishment of a TR program improved PCI safety at a teaching hospital. TR programs are likely to improve PCI safety at other teaching hospitals and should be established in all cardiology fellowship training programs.
authors.affiliation: Division of Cardiology, Medical University of South Carolina, Charleston, USA. leonarda@musc.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Leonardi
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Townsend
authors.forename: D Dirk
authors.initials: DD
authors.lastname: Bonnema
authors.forename: Chetan A
authors.initials: CA
authors.lastname: Patel
authors.forename: Michael T
authors.initials: MT
authors.lastname: Gibbons
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Todoran
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Nielsen
authors.forename: Eric R
authors.initials: ER
authors.lastname: Powers
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000193:education* / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D002309:Cardiology / Q000193:education; D002983:Clinical Competence; D004363:Drug Utilization; D005257:Fellowships and Scholarships; D005260:Female; D005471:Fluoroscopy; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010446:Peptide Fragments / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D017534:Radial Artery; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013022:South Carolina
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin