title: Is There a Relationship of Operator and Center Volume With Access Site-Related Outcomes? An Analysis From the British Cardiovascular Intervention Society.
abstract: BACKGROUND
  Transradial access is associated with reduced access site-related bleeding complications and mortality post percutaneous coronary intervention. The objective of this study is to examine the relationship between access site practice and clinical outcomes and how this may be influenced by operator and center experience/expertise.
  
  
  RESULTS
  The influence of operator and center experience/expertise was studied on 30-day mortality, in-hospital major adverse cardiovascular events (a composite of in-hospital mortality and in-hospital myocardial infarction and target vessel revascularization) and in-hospital major bleeding based on access site adopted (radial versus femoral). Operator/center experience/expertise were defined by both total volume and transradial access proportion. A total of 164 395 procedures between 2012 and 2013 in the National Health Service in England and Wales were analyzed. After case-mix adjustment, transradial access was associated with an average odds reduction of 39% for 30-day mortality compared with transfemoral access (odds ratio, 0.61; 95% confidence interval, 0.55-0.68; P<0.001). The magnitude of this risk reduction was modified by increases in total procedural volume and radial proportion at the operator level (odds ratio reduction of 11% per 100 extra procedures, 95% confidence interval, 3%-19%; odds ratio reduction of 6% per 10%-point increase in radial proportion, 95% confidence interval, 1%-11%) with no significant impact of operator radial volume, center total volume, center radial volume, and center radial proportion.
  
  
  CONCLUSIONS
  The lower mortality associated with transradial access adoption relates to both the total procedural volume and the proportion of procedures undertaken radially by operator, with operators undertaking the greatest proportion of their procedures radially having the largest relative reduction in mortality risk.
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: William
authors.initials: W
authors.lastname: Hulme
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Sperrin
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Helen
authors.initials: H
authors.lastname: Rushton
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Mark
authors.initials: M
authors.lastname: De Belder
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: Iain
authors.initials: I
authors.lastname: Buchan
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.).
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: From the Farr Institute, Institute of Population Health, University of Manchester, Manchester, United Kingdom (W.H., M.S., H.R., I.B., M.A.M.); Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom (P.F.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.D.B.); Department of Cardiology, Faculty of Medicine, University of Southampton, Southampton, United Kingdom (N.C.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); Keele Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care and Health Sciences, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.); and Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands Trust, Stoke-on-Trent, United Kingdom (C.S.K., J.N., M.A.M.). mamasmamas1@yahoo.co.uk.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000368:Aged; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D011364:Professional Practice; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom
keywords: hemorrhage; mortality; myocardial infarction; percutaneous coronary intervention; risk reduction