title: Switching from femoral to routine radial access site for ST-elevation myocardial infarction: a single center experience.
abstract: OBJECTIVE
  This study sought to describe the change of first choice access site from transfemoral (TF) to transradial (TR) in primary percutaneous coronary intervention (pPCI) in a single center.
  
  
  BACKGROUND
  TR-pPCI, when performed by experienced operators, can reduce bleeding events and improve clinical outcome. However, little is known about the learning curve of TR-pPCI and the results obtained by less experienced operators.
  
  
  METHODS
  Time to reperfusion, contrast and radiation doses, and 30-day clinical events were evaluated. The relationship between operator experience and procedural results was assessed.
  
  
  RESULTS
  During 6.5 years, 1,045 patients with STEMI underwent pPCI. The rate of TR-pPCI increased gradually from about 40% to 90% and remained stable thereafter. The crossover from TR to TFpPCI occurred in 4.6% of patients and was not related to the operator experience. Patients selected for TR-pPCI had a lower risk profile and lower incidence of 30-day mortality and bleeding events. Time to reperfusion, contrast volume, fluoroscopy time, and angiographic success was not significantly different between the 2 vascular approaches, nor was it associated to the operator experience. At roughly 200 PCIs as operator experience, a slight adjusted reduction in the time form first coronary angiogram to balloon was detected with both vascular approaches.
  
  
  CONCLUSIONS
  A progressive transition from TF to TR-pPCI could be implemented over a 4-year period without increasing overall treatment delay. The impact of operator experience on procedural results appeared to be modest and it did not differ in the study access groups.
authors.affiliation: Department of Cardiology, ASL3 Ospedale Villa Scassi, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rubartelli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Crimi
authors.forename: Davide
authors.initials: D
authors.lastname: Bartolini
authors.forename: Sandro
authors.initials: S
authors.lastname: Bellotti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Iannone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fontana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D005263:Femoral Artery; D006801:Humans; D059032:Learning Curve; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery