Transradial and transfemoral coronary angiography and interventions

1-Year outcomes after initiating the transradial approach in a cardiology training program

Christopher R. Balwanz, Usman Javed, Gagan Singh, Ehrin J. Armstrong, Jeffrey Southard, Garrett B Wong, Khung Keong Yeo, Reginald Low, John R. Laird, Jason H Rogers

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17 Citations (Scopus)

Abstract

Background: Limited data are available regarding the safety and feasibility of initiating transradial (TR) diagnostic coronary angiography (CA) and percutaneous coronary intervention (PCI) in cardiology fellowship programs. Methods: From July 2010 to June 2011, University of California, Davis Medical Center, adopted the TR approach with supervised cardiology fellows as the primary operators. Procedural variables and clinical outcomes of TR and transfemoral (TF) procedures were compared. To minimize confounding variables, ST-elevation myocardial infarction, bypass graft interventions, chronic total occlusions, and procedures with concomitant right heart catheterizations were excluded. To reflect the learning curve of the TR approach, this experience was assessed in 2 sequential 6-month periods. Results: A total of 402 diagnostic CAs and 255 PCIs were included. Transradial access was used in 141 (35%) of the CAs and in 72 (28%) of PCIs. Within the TR-CA and TF-CA (n = 261) groups, there was no difference between fluoroscopy (10.4 ± 6.0 vs 11.0 ± 8.9, P =.63) or procedure (31.8 ± 11.5 vs 33.2 ± 13.8, P =.55) time throughout the academic year with a significant trend toward lower contrast use (128 ± 52 vs 110 vs 50, P =.04) by the second half. In addition, during the second half of the academic year, the TR-CA showed significantly higher fluoroscopy (11.0 ± 8.9 vs 6.7 ± 6.8, P =.001) and procedure (33.2 ± 13.8 vs 27.2 ± 11.6, P =.0015) times when compared with TF-CA. Transfemoral PCI (n = 183) and TR-PCI showed no significant difference between all fluoroscopy and procedure time and contrast use when comparing the 2 halves of the academic year. When comparing TF with TR within each academic half year, there was no difference within the PCI group. Vascular complications were less with the TR approach. Overall procedural success rates were high, and there were low rates of crossover and periprocedural complications in both the TR and the TF groups. Conclusion: A TR approach is safe for CA and PCI when performed by supervised operators in training. Although the learning curve for trainees appears slower for TR-CA compared with TF-CA, cardiology fellowship training programs should be encouraged to adopt TR procedures as part of their curriculum.

Original languageEnglish (US)
Pages (from-to)310-316
Number of pages7
JournalAmerican Heart Journal
Volume165
Issue number3
DOIs
StatePublished - Mar 2013

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Cardiology
Coronary Angiography
Percutaneous Coronary Intervention
Education
Fluoroscopy
Learning Curve
Confounding Factors (Epidemiology)
Cardiac Catheterization
Curriculum
Blood Vessels
Transplants
Safety

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transradial and transfemoral coronary angiography and interventions : 1-Year outcomes after initiating the transradial approach in a cardiology training program. / Balwanz, Christopher R.; Javed, Usman; Singh, Gagan; Armstrong, Ehrin J.; Southard, Jeffrey; Wong, Garrett B; Yeo, Khung Keong; Low, Reginald; Laird, John R.; Rogers, Jason H.

In: American Heart Journal, Vol. 165, No. 3, 03.2013, p. 310-316.

Research output: Contribution to journalArticle

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abstract = "Background: Limited data are available regarding the safety and feasibility of initiating transradial (TR) diagnostic coronary angiography (CA) and percutaneous coronary intervention (PCI) in cardiology fellowship programs. Methods: From July 2010 to June 2011, University of California, Davis Medical Center, adopted the TR approach with supervised cardiology fellows as the primary operators. Procedural variables and clinical outcomes of TR and transfemoral (TF) procedures were compared. To minimize confounding variables, ST-elevation myocardial infarction, bypass graft interventions, chronic total occlusions, and procedures with concomitant right heart catheterizations were excluded. To reflect the learning curve of the TR approach, this experience was assessed in 2 sequential 6-month periods. Results: A total of 402 diagnostic CAs and 255 PCIs were included. Transradial access was used in 141 (35{\%}) of the CAs and in 72 (28{\%}) of PCIs. Within the TR-CA and TF-CA (n = 261) groups, there was no difference between fluoroscopy (10.4 ± 6.0 vs 11.0 ± 8.9, P =.63) or procedure (31.8 ± 11.5 vs 33.2 ± 13.8, P =.55) time throughout the academic year with a significant trend toward lower contrast use (128 ± 52 vs 110 vs 50, P =.04) by the second half. In addition, during the second half of the academic year, the TR-CA showed significantly higher fluoroscopy (11.0 ± 8.9 vs 6.7 ± 6.8, P =.001) and procedure (33.2 ± 13.8 vs 27.2 ± 11.6, P =.0015) times when compared with TF-CA. Transfemoral PCI (n = 183) and TR-PCI showed no significant difference between all fluoroscopy and procedure time and contrast use when comparing the 2 halves of the academic year. When comparing TF with TR within each academic half year, there was no difference within the PCI group. Vascular complications were less with the TR approach. Overall procedural success rates were high, and there were low rates of crossover and periprocedural complications in both the TR and the TF groups. Conclusion: A TR approach is safe for CA and PCI when performed by supervised operators in training. Although the learning curve for trainees appears slower for TR-CA compared with TF-CA, cardiology fellowship training programs should be encouraged to adopt TR procedures as part of their curriculum.",
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T2 - 1-Year outcomes after initiating the transradial approach in a cardiology training program

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AU - Javed, Usman

AU - Singh, Gagan

AU - Armstrong, Ehrin J.

AU - Southard, Jeffrey

AU - Wong, Garrett B

AU - Yeo, Khung Keong

AU - Low, Reginald

AU - Laird, John R.

AU - Rogers, Jason H

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N2 - Background: Limited data are available regarding the safety and feasibility of initiating transradial (TR) diagnostic coronary angiography (CA) and percutaneous coronary intervention (PCI) in cardiology fellowship programs. Methods: From July 2010 to June 2011, University of California, Davis Medical Center, adopted the TR approach with supervised cardiology fellows as the primary operators. Procedural variables and clinical outcomes of TR and transfemoral (TF) procedures were compared. To minimize confounding variables, ST-elevation myocardial infarction, bypass graft interventions, chronic total occlusions, and procedures with concomitant right heart catheterizations were excluded. To reflect the learning curve of the TR approach, this experience was assessed in 2 sequential 6-month periods. Results: A total of 402 diagnostic CAs and 255 PCIs were included. Transradial access was used in 141 (35%) of the CAs and in 72 (28%) of PCIs. Within the TR-CA and TF-CA (n = 261) groups, there was no difference between fluoroscopy (10.4 ± 6.0 vs 11.0 ± 8.9, P =.63) or procedure (31.8 ± 11.5 vs 33.2 ± 13.8, P =.55) time throughout the academic year with a significant trend toward lower contrast use (128 ± 52 vs 110 vs 50, P =.04) by the second half. In addition, during the second half of the academic year, the TR-CA showed significantly higher fluoroscopy (11.0 ± 8.9 vs 6.7 ± 6.8, P =.001) and procedure (33.2 ± 13.8 vs 27.2 ± 11.6, P =.0015) times when compared with TF-CA. Transfemoral PCI (n = 183) and TR-PCI showed no significant difference between all fluoroscopy and procedure time and contrast use when comparing the 2 halves of the academic year. When comparing TF with TR within each academic half year, there was no difference within the PCI group. Vascular complications were less with the TR approach. Overall procedural success rates were high, and there were low rates of crossover and periprocedural complications in both the TR and the TF groups. Conclusion: A TR approach is safe for CA and PCI when performed by supervised operators in training. Although the learning curve for trainees appears slower for TR-CA compared with TF-CA, cardiology fellowship training programs should be encouraged to adopt TR procedures as part of their curriculum.

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