title: Change in hospital-level use of transradial percutaneous coronary intervention and periprocedural outcomes: insights from the national cardiovascular data registry.
abstract: BACKGROUND
  Whether increasing use of radial access has improved percutaneous coronary intervention outcomes remains unknown. We sought to determine the relationship between increasing facility-level use of transradial percutaneous coronary intervention (TRI) and periprocedural outcomes.
  
  
  RESULTS
  Within the National Cardiovascular Data Registry CathPCI Registry, we estimated the risk-adjusted association between hospital category of change in TRI use (during the 3-year period from 2009 to 2012) and trends in access site and overall bleeding, fluoroscopy time, and contrast use among 818 facilities with low baseline TRI use. There were 4 categories of hospital change in TRI use: very low (baseline, 0.2% increasing to 1.8% at the end of 3 years), low (0.9% increasing to 8.9%), moderate (1.6% increasing to 27.2%), and high (1.0% increasing to 45.1%). Risk-adjusted access site bleeding decreased over time for all hospital categories; however, the rate of decline varied across hospital categories (P for interaction, <0.001). The decrease in access site bleeding was significantly greater for hospitals with moderate or high increases in TRI use (relative risk, 0.45, 95% confidence interval, 0.36-0.56) when compared with that of very low or low hospitals (relative risk, 0.65; 95% confidence interval, 0.58-0.74; P for comparison, 0.002). Similar findings were observed for overall bleeding. An increase in fluoroscopy time (≈1.3 minutes) was noted at hospitals with moderate and high use of TRI (P=0.01). Trends in contrast use were similar across hospital categories.
  
  
  CONCLUSIONS
  In a national sample of hospitals performing percutaneous coronary intervention, bleeding rates decreased over time for all hospital categories of change in TRI use. The decline in bleeding outcomes was larger at hospitals with increased adoption of TRI when compared with hospitals with minimal or no change in TRI use.
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.). Steven.Bradley@va.gov.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Bradley
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
authors.forename: Craig S
authors.initials: CS
authors.lastname: Parzynski
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Daugherty
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: From the Veterans Affairs Eastern Colorado Health Care System and the Colorado Cardiovascular Outcomes Research Consortium, Denver (S.M.B., J.S.R.); University of Colorado School of Medicine, Aurora (S.M.B., J.C.M., S.L.D., J.S.R.); The Duke Clinical Research Institute, Durham, NC (S.V.R.); Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation and the Yale University School of Medicine, CT (J.P.C., C.S.P.); and University of Michigan Medical School, Ann Arbor (H.S.G.).
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data*; D017534:Radial Artery; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: hemorrhage; hospitals; outcomes assessment; percutaneous coronary intervention