Adoption of transradial percutaneous coronary intervention and outcomes according to center radial volume in the Veterans Affairs Healthcare system: insights from the Veterans Affairs clinical assessment, reporting, and tracking (CART) program.
BACKGROUND
Studies examining the association between radial approach and post-percutaneous coronary intervention (PCI) bleeding and mortality have reached conflicting conclusions. There are no current data about the use and outcomes of transradial PCI (r-PCI) in the Veterans Affairs system.


RESULTS
Consecutive veterans (n=24143 patients) undergoing PCI in the Veterans Affairs between 2007 and 2010 were examined. On the basis of propensity to undergo r-PCI, 3 cohorts matched with veterans undergoing transfemoral access were constructed among sites performing ≥ 1 r-PCI, ≥ 50 r-PCI (high volume), and <50 r-PCI (low volume). Cox proportional hazard models were used to determine the association between PCI access site, blood transfusion, and mortality. The prevalence of r-PCI increased over time (2007=2.1%; 2010=8.8%). Overall, there was no difference in procedure success between matched groups (r-PCI 97.3% versus transfemoral PCI 96.6%; P=0.182), or in the risk of postprocedure transfusion or mortality. Among matched patients treated at high r-PCI volume sites, radial access was associated with a decreased risk of post-PCI blood transfusion (hazard ratio, 0.4; 95% confidence interval, 0.3-0.7; P<0.001), and no significant difference in the risk of mortality (hazard ratio, 0.7; 95% confidence interval, 0.4-1.3; P=0.279).


CONCLUSIONS
Within the Veterans Affairs, the use of r-PCI increased over time. r-PCI may be associated with a significant decreased risk of post-PCI blood transfusion among higher volume r-PCI sites. These data demonstrate that potential benefits of r-PCI in terms of reduced post-PCI blood transfusions may be more pronounced at sites that routinely use radial access.
Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. Antonio.Gutierrez3@va.gov
Antonio
A
Gutierrez
Thomas T
TT
Tsai
Maggie A
MA
Stanislawski
Mladen
M
Vidovich
Christopher L
CL
Bryson
Deepak L
DL
Bhatt
Gary K
GK
Grunwald
John
J
Rumsfeld
Sunil V
SV
Rao
D000368:Aged; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D017534:Radial Artery; D014481:United States; D014493:United States Department of Veterans Affairs
blood transfusion; hemorrhage; percutaneous coronary intervention; radial artery