Abstract 9428: Characterization of the Learning Curve in Transradial Percutaneous Coronary Interventions
Background: The transradial approach (TR) for percutaneous coronary intervention (PCI) reduces vascular complications compared to transfemoral approach (TF). However, technical challenges and lack of experience with radial sheaths and guide catheters have limited widespread adoption of TR-PCI. In this study, we characterized the learning curve of TR-PCI to identify minimum procedure volumes needed to optimize clinical benefit.
Methods: Clinical and procedural characteristics were prospectively collected for all patients undergoing TR-PCI at a tertiary care center from 1999 to 2008. TR-PCI cases were rank ordered chronologically from first to last for all operators who performed their first TR-PCI at the institution or had career TR-PCI volume > 300 before 1999. Cases were stratified into novice (1–50), very low (51–100), low (101–150) intermediate (150 -300) and high (>300) according to operator TR-PCI volume. TR-PCI success rates, number of guides, fluoroscopy time and contrast volume rates were compared between rank ordered groups for planned single vessel TR-PCI.
Results: During the study period 2445 patients underwent TR-PCI. 1697 patients undergoing single vessel planned TR-PCI were included in the analysis. There were no significant differences in baseline characteristics between the study groups. The procedural characteristics are presented in Table 1.
Conclusions: TR-PCI can be performed with a high level of success. A minimum of 50 TR-PCI cases are required for new operators to optimize procedural success and minimize contrast use. However, performing more than 100 cases does not result in any further improvement in procedural success, contrast use or fluoroscopy time compared to highly experienced TR operators.
- © 2010 by American Heart Association, Inc.