Abstract 15219: Changing from a Predominant Transfemoral to Transradial Access Site Percutaneous Coronary Intervention Centre (PCI) : Less Vascular Complications, Shortened Lengths of Stay - The Way Forward?
Background: As PCI via the radial (R) route continues to gain wider acceptance over the femoral (F) route, little information is available on the learning curve in adopting this technique. We examined the change in practice with regard to PCI access site in a high volume single centre in the UK.
Methods: Prospective study examining the procedures and outcomes of all PCI`s between Jan 2006 and Dec 2010. The centre performed between 1000-1420 PCI`s annually with most operators using predominantly (F) access for PCI then progressing to the (R) approach. Clinical and procedure data was collected from internal and national databases.
Results: 6575 patients had successful PCI over the 5 years. In year (yr) 1, (R) access was used in 31.4% of cases but significantly increased to 90.1% by yr 5 (p<0.0001). The change from (F) to (R) access was observed amongst all operators and all patients - gender, age, clinical presentation and lesion type. There was no difference in the use of diagnostic and intervention devices in both (F) and (R) cohorts, including rotablation. Crossover rates from (R) to (F) access to complete the PCI procedure was only 1.54%. In the (R) cohort, both fluoroscopy times and radiation doses were higher in yr 1 ((R) 1097 vs (F) 851 s, p=0.001; (R) 63 vs (F) 57 cGy cm2, p=0.01) when default (F) operators had increased their experience using the (R) route from 32-67% of cases. This difference was not seen over the transition period (yr2+3) but was reversed during yr 4+5, when use of the (R) approach totalled 90% of cases ((R) 919 vs (F) 1124 s, p=0.007; (R) 70 vs (F) 86 cGy cm2, p=0.01). Cumulative vascular complication and major bleeding rates were significantly higher in the (F) cohort (2.32% vs 1.00%, p<0.001; 1.12% vs 0.10%, p<0.0001) while hospital stay was shorter in the (R) group (0.75 vs 1.07 days, p<0.0001). Periprocedural death rates were similar in both groups (0.41% vs 0.79%, p = ns).
Conclusion: Adoption of the (R) approach in (F) centres is feasible within five years and translates into both clinical and economic benefits with reductions in hospital stay and vascular/bleeding complications. There is however a ‘learning curve’ which results in increased fluoroscopy time and radiation doses in the initial phase, which is reversed once the (R) approach is used in >60% of cases.
- © 2012 by American Heart Association, Inc.