title: Institutional Switch from Transfemoral to Transradial Vascular Access for Percutaneous Coronary Intervention was Associated with a Reduction in Bleeding Events: A Singlecenter Experience of >10,000 Consecutive Cases.
abstract: BACKGROUND
  Transradial (TR) access for percutaneous coronary intervention (PCI) reduces bleeding compared with transfemoral (TF) access, and may reduce mortality in specific patient subsets. However, switching from TF to TR access is associated with a learning curve and it is unclear whether benefits observed in randomized trials translate into practice. We sought to characterize the trends in bleeding and mortality rates at our institution, as we changed from being a TF to predominantly TR center over a 5-year period.
  
  
  RESULTS
  10,213 consecutive patients presenting for PCI were included (mean age 65.0 ± 11.6 years, 76.1% male, 48.0% PCI for acute coronary syndrome) over 5 years at a single center with PCI volume >2,000 cases per annum. Patients were stratified by initial arterial access site (TR or TF) and outcome measures included temporal trends in TR procedural failure, 30-day bleeding complications and all-cause 1-year mortality. TR procedural failure fell to a consistently low rate within 1 year (11.8% in 2008 to 2.9% in 2009, P < 0.001). As TR volume increased, the annual 30-day bleeding rate fell (1.64% in 2008 to 0.68% in 2012, P = 0.006). TR access predicted reduced 30-day bleeding (OR 0.17 [95%CI 0.07-0.38], P < 0.001), but was not a predictor of 1-year survival (HR 0.78 [95%CI 0.58-1.05], P = 0.10).
  
  
  CONCLUSIONS
  Successful transition from TF to TR PCI at our institution was rapid and associated with a reduction in 30-day bleeding. These data should encourage other centers considering the adoption of TR access.
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Nikil K
authors.initials: NK
authors.lastname: Rajani
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Brown
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Liam M
authors.initials: LM
authors.lastname: McCormick
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Hammad
authors.initials: H
authors.lastname: Parwaiz
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Anmol
authors.initials: A
authors.lastname: Kaushal
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hoole
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Nick E J
authors.initials: NE
authors.lastname: West
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery; D051436:Renal Insufficiency, Chronic / Q000401:mortality; D012770:Shock, Cardiogenic / Q000401:mortality; D006113:United Kingdom / Q000453:epidemiology