The Pace of Transradial Procedural Learning
The uptake of transradial coronary intervention (TRI) in the Unites States has been slow relative to other countries.1 Fortunately, adoption appears to be on the rise, with a steady increase in the overall percentage of TRI since 2009.2 Learning curves, similar to adoption curves, are generally not linear. When learning or proficiency is plotted against time, progress may be slow at first, and then there is a period of rapid change followed by an apparent plateau.3 Although small improvements are made continuously after the plateau, the progress may not be visible until there is an extended period of observation. Surprisingly, for many different motor or procedural skills, the shape of the learning curve is similar, and there is less variance in performance as experience increases.4 Although numerous studies have examined the benefits of TRI on outcomes, there has been little formal study of requirements to become a proficient TRI operator. Several factors may influence the slope of the TRI learning curve, including the cumulative interventional experience of the operator and availability of resources for training.
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In this issue of Circulation, Hess and colleagues5 elucidate the learning curve for TRI in operators adopting the transradial approach in the United States from 2009 to 2012. With the use of data from 54 561 procedures in the National Cardiovascular Data Registry performed by 942 operators at 704 sites, measures of technical proficiency including fluoroscopy time, contrast volume, and procedural success were assessed according to TRI case volume. In hospital outcomes including mortality, vascular complications and bleeding were also assessed. Operators were considered new transradial operators and were included in the analysis if they had no TRI procedures for a 6-month blanking period during which time they performed ≥1 femoral percutaneous coronary intervention (PCI). …