title: Changes in Arterial Access Site and Association With Mortality in the United Kingdom: Observations From a National Percutaneous Coronary Intervention Database.
abstract: BACKGROUND
  The transradial access (TRA) site has become the default access site for percutaneous coronary intervention in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use. This study evaluates regional changes in access site practice in England and Wales over time, examines whether changes in access site practice have been uniform nationally and across different patient subgroups, and provides national estimates for the potential number of lives saved or lost associated with regional differences in access site practice.
  
  
  RESULTS
  Using the British Cardiovascular Intervention Society database, we investigated outcomes for growth of TRA in different regions in England and Wales in 448 853 patients who underwent percutaneous coronary intervention from 2005 to 2012. Multiple logistic regression was used to quantify the effect of TRA on 30-day mortality and quantify lives saved and lost by differences in TRA adoption. TRA use increased from 14.0% to 58.6% in 417 038 PCI patients with large variations in different parts of the country. TRA was independently associated with a decreased risk of 30-day mortality (odds ratio=0.70; 95% confidence interval=0.66-0.74), with significant but small differences observed across different regions. The number of estimated lives saved was 450 (95% confidence interval=275-650), and we estimate that an additional 264 (95% confidence interval=153-399) lives would have been saved if TRA adoption were uniform nationally.
  
  
  CONCLUSIONS
  TRA has become the dominant percutaneous coronary intervention approach in the United Kingdom, with a wide variation in different parts of the country. Changes in practice have contributed to mortality reductions, and inequalities have resulted in missed opportunities for further improvements.
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.). mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: From Keele Cardiovascular Research Group, University of Keele, Stoke-on-Trent, UK (M.A.M., J.N.); Farr Institute (M.A.M., I.B., E.K.) and Cardiovascular Institute (M.A.M., C.S.K.), University of Manchester, UK; University Hospital of North Midlands, Stoke-on-Trent, United Kingdom (M.A.M., J.N.); James Cook University Hospital, Middleborough, UK (M.A.d.B.); Freemans Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK (A.Z.); Department of Cardiology, University Hospital of Wales, Cardiff, UK (T.K.); University Hospital Southampton & Faculty of Medicine, University of Southampton, UK (N.C.); and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK (P.L.).
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
mesh_terms: D016208:Databases, Factual / Q000639:trends*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D017534:Radial Artery / Q000601:surgery*; D006113:United Kingdom / Q000453:epidemiology
keywords: angioplasty; catheterization; mortality; transradial