title: Switching from transfemoral to transradial access for PCI: a single-center learning curve over 5 years.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) via the transradial (TR) route is an increasingly popular alternative to the transfemoral (TF) route. However, there are limiting factors to its adoption. We report the learning curve over 5 years in a high-volume PCI center during the crossover from TF to TR access for PCI.
  
  
  OBJECTIVE
  To evaluate clinical characteristics, radiation doses, screening times, and subsequent clinical outcomes in subjects with femoral and radial access sites for PCI.
  
  
  METHODS
  We retrospectively analyzed our databases for PCI procedures/outcomes of all patients from 2006-2010.
  
  
  METHODS
  A university teaching hospital PCI center performing cases predominantly femorally at the beginning of the study period, and transitioning to a predominantly radial access center at the end of the study period.
  
  
  METHODS
  All patients undergoing PCI via either femoral or radial approach over a 5-year period.
  
  
  RESULTS
  In year 1, TR access was used in 31.4% of cases; this rate increased to 90.1% in year 5. The switch from TF to TR access was observed among all operators and all groups of patients regardless of presentation, gender, age, and lesion complexity. In year 1, fluoroscopy times and radiation doses were higher in the TR group, but equalized in years 2 and 3 and reversed during years 4 and 5 when the TR rate was >90%. Over 5 years, the rates of vascular complications and major bleeding were higher in the TF cohort and were associated with longer hospital stay. In-hospital mortality was lower in the TR group.
  
  
  CONCLUSIONS
  The change from TF to TR approach for PCI in a high-volume center is achievable within 5 years, and results in marked clinical benefits. There was an initial learning curve for fluoroscopy time and radiation dose, but this improved once an operator performed >60% of cases radially.
authors.affiliation: Cardiology Department, University Hospital of Wales, Cardiff, CF4 4XW, United Kingdom. Richard.Anderson@wales.nhs.uk.
authors.forename: Shantu
authors.initials: S
authors.lastname: Bundhoo
authors.forename: Ganesh
authors.initials: G
authors.lastname: Nallur-Shivu
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ossei-Gerning
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.forename: Tim D
authors.initials: TD
authors.lastname: Kinnaird
authors.forename: Richard A
authors.initials: RA
authors.lastname: Anderson
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D005260:Female; D005263:Femoral Artery; D005471:Fluoroscopy / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D061847:Hospitals, High-Volume; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000193:education* / Q000706:statistics & numerical data; D058996:Quality Improvement; D017534:Radial Artery; D011829:Radiation Dosage; D014600:Utilization Review / Q000706:statistics & numerical data; D014852:Wales