title: Variation in Arterial Access for Invasive Coronary Procedures in New Zealand: A National Analysis (ANZACS-QI 5).
abstract: BACKGROUND
  Radial arterial access (RA) and femoral arterial access (FA) rates for invasive coronary angiography (ICA) vary widely internationally. The European Society of Cardiology (ESC) suggests default RA is feasible. We aim to investigate the variation in RA rates across all New Zealand public hospitals.
  
  
  RESULTS
  Patient characteristics, procedural details, and inpatient outcome data were collected in the All New Zealand Acute Coronary Syndrome - Quality Improvement (ANZACS-QI) registry on consecutive patients undergoing ICA over five months. Of the 5894 ICAs 81% were via RA. Hospitals averaged 25 - 176 procedures/month (46.5% - 96.4% via RA). Operators averaged 17 procedures/month. Those performing more than 20 ICAs/month had RA rates between 61% - 99%. Of the 75 operators, 69% met the ESC recommendation. After multivariable adjustment higher operator (RR 1.12, CI 1.09 - 1.30) and hospital (RR 1.21, CI 1.15 - 1.28) volume were independent predictors of RA. Those with prior CABG (RR 0.51, CI 0.45 - 0.57), STEMI <12h (RR 0.91, CI 0.87 - 0.96), and female sex (RR 0.96, CI 0.94 - 0.99) were less likely to receive RA.
  
  
  CONCLUSIONS
  New Zealand has a high RA rate for ICAs. Rates vary substantially between both operators and centres. Radial arterial was highest amongst the highest volume operators and centres.
authors.affiliation: Cardiology Department, Middlemore Hospital, Auckland, NZ. Electronic address: Peter.r.barr@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Barr
authors.affiliation: Cardiology Department, Christchurch Hospital, Christchurch, NZ.
authors.forename: D
authors.initials: D
authors.lastname: Smyth
authors.affiliation: School of Biological Science, Victoria University, Wellington, NZ.
authors.forename: S A
authors.initials: SA
authors.lastname: Harding
authors.affiliation: Cardiology Department, North Shore Hospital, Auckland, NZ.
authors.forename: S
authors.initials: S
authors.lastname: El-Jack
authors.affiliation: Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, NZ.
authors.forename: M J A
authors.initials: MJ
authors.lastname: Williams
authors.affiliation: Medicine, University of Auckland, Auckland, NZ.
authors.forename: G
authors.initials: G
authors.lastname: Devlin
authors.affiliation: Cardiology Department, Auckland City Hospital, Auckland, NZ.
authors.forename: J
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Flynn
authors.affiliation: Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Lee
authors.affiliation: Medicine, University of Auckland, Auckland, NZ.
authors.forename: A J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017534:Radial Artery
keywords: Access site; Cardiac catheterisation.; Radial artery catheter