Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction

Insights From the NCDR CathPCI Registry

Javier A. Valle, Lisa A. Kaltenbach, Steven M. Bradley, Robert W. Yeh, Sunil V. Rao, Hitinder S. Gurm, Ehrin J. Armstrong, John C. Messenger, Stephen W. Waldo

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives The study sought to define patient, operator, and institutional factors associated with transradial access (TRA) in ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding. Background TRA for PCI in STEMI is underutilized. Factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes. Methods The authors used hierarchical logistic regression to identify patient, operator, and institutional characteristics associated with TRA use as well as determine the variation in TRA for STEMI PCI from 2009 to 2015. They also described the relationship between operator- and institution-level use and risk-adjusted bleeding and mortality. Results Among 692,433 patients undergoing STEMI PCI, 12% (n = 82,618) utilized TRA. TRA increased from 2% to 23% from 2009 to 2015, but with significant geographic variation. Age, sex, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and nonacademically affiliated institutions were associated with lower rates of TRA. There was significant operator and institutional variation, wherein identical patients would have >8-fold difference in odds of TRA for STEMI PCI by changing operators (median odds ratio: 8.7), and >5-fold difference by changing institutions (median odds ratio: 5.1). Greater TRA use across operators was associated with reduced bleeding (rho = −0.053), whereas TRA use across institutions was associated with reduced mortality (rho = −0.077). Conclusions Transradial access for STEMI PCI is increasing, but remains underutilized with significant geographic, operator, and institutional variation. These findings suggest an ongoing opportunity to standardize STEMI care.

Original languageEnglish (US)
Pages (from-to)2242-2254
Number of pages13
JournalJACC: Cardiovascular Interventions
Volume10
Issue number22
DOIs
StatePublished - Nov 27 2017
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Registries
Hemorrhage
Mortality
Odds Ratio
Cardiogenic Shock
ST Elevation Myocardial Infarction
Heart Arrest
Logistic Models

Keywords

  • mortality
  • outcomes
  • PCI
  • STEMI
  • transradial

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction : Insights From the NCDR CathPCI Registry. / Valle, Javier A.; Kaltenbach, Lisa A.; Bradley, Steven M.; Yeh, Robert W.; Rao, Sunil V.; Gurm, Hitinder S.; Armstrong, Ehrin J.; Messenger, John C.; Waldo, Stephen W.

In: JACC: Cardiovascular Interventions, Vol. 10, No. 22, 27.11.2017, p. 2242-2254.

Research output: Contribution to journalArticle

Valle, JA, Kaltenbach, LA, Bradley, SM, Yeh, RW, Rao, SV, Gurm, HS, Armstrong, EJ, Messenger, JC & Waldo, SW 2017, 'Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction: Insights From the NCDR CathPCI Registry', JACC: Cardiovascular Interventions, vol. 10, no. 22, pp. 2242-2254. https://doi.org/10.1016/j.jcin.2017.07.020
Valle, Javier A. ; Kaltenbach, Lisa A. ; Bradley, Steven M. ; Yeh, Robert W. ; Rao, Sunil V. ; Gurm, Hitinder S. ; Armstrong, Ehrin J. ; Messenger, John C. ; Waldo, Stephen W. / Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction : Insights From the NCDR CathPCI Registry. In: JACC: Cardiovascular Interventions. 2017 ; Vol. 10, No. 22. pp. 2242-2254.
@article{1f2bbac4d38e427bb16ead0d834ceb1a,
title = "Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction: Insights From the NCDR CathPCI Registry",
abstract = "Objectives The study sought to define patient, operator, and institutional factors associated with transradial access (TRA) in ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding. Background TRA for PCI in STEMI is underutilized. Factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes. Methods The authors used hierarchical logistic regression to identify patient, operator, and institutional characteristics associated with TRA use as well as determine the variation in TRA for STEMI PCI from 2009 to 2015. They also described the relationship between operator- and institution-level use and risk-adjusted bleeding and mortality. Results Among 692,433 patients undergoing STEMI PCI, 12{\%} (n = 82,618) utilized TRA. TRA increased from 2{\%} to 23{\%} from 2009 to 2015, but with significant geographic variation. Age, sex, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and nonacademically affiliated institutions were associated with lower rates of TRA. There was significant operator and institutional variation, wherein identical patients would have >8-fold difference in odds of TRA for STEMI PCI by changing operators (median odds ratio: 8.7), and >5-fold difference by changing institutions (median odds ratio: 5.1). Greater TRA use across operators was associated with reduced bleeding (rho = −0.053), whereas TRA use across institutions was associated with reduced mortality (rho = −0.077). Conclusions Transradial access for STEMI PCI is increasing, but remains underutilized with significant geographic, operator, and institutional variation. These findings suggest an ongoing opportunity to standardize STEMI care.",
keywords = "mortality, outcomes, PCI, STEMI, transradial",
author = "Valle, {Javier A.} and Kaltenbach, {Lisa A.} and Bradley, {Steven M.} and Yeh, {Robert W.} and Rao, {Sunil V.} and Gurm, {Hitinder S.} and Armstrong, {Ehrin J.} and Messenger, {John C.} and Waldo, {Stephen W.}",
year = "2017",
month = "11",
day = "27",
doi = "10.1016/j.jcin.2017.07.020",
language = "English (US)",
volume = "10",
pages = "2242--2254",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "22",

}

TY - JOUR

T1 - Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction

T2 - Insights From the NCDR CathPCI Registry

AU - Valle, Javier A.

AU - Kaltenbach, Lisa A.

AU - Bradley, Steven M.

AU - Yeh, Robert W.

AU - Rao, Sunil V.

AU - Gurm, Hitinder S.

AU - Armstrong, Ehrin J.

AU - Messenger, John C.

AU - Waldo, Stephen W.

PY - 2017/11/27

Y1 - 2017/11/27

N2 - Objectives The study sought to define patient, operator, and institutional factors associated with transradial access (TRA) in ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding. Background TRA for PCI in STEMI is underutilized. Factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes. Methods The authors used hierarchical logistic regression to identify patient, operator, and institutional characteristics associated with TRA use as well as determine the variation in TRA for STEMI PCI from 2009 to 2015. They also described the relationship between operator- and institution-level use and risk-adjusted bleeding and mortality. Results Among 692,433 patients undergoing STEMI PCI, 12% (n = 82,618) utilized TRA. TRA increased from 2% to 23% from 2009 to 2015, but with significant geographic variation. Age, sex, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and nonacademically affiliated institutions were associated with lower rates of TRA. There was significant operator and institutional variation, wherein identical patients would have >8-fold difference in odds of TRA for STEMI PCI by changing operators (median odds ratio: 8.7), and >5-fold difference by changing institutions (median odds ratio: 5.1). Greater TRA use across operators was associated with reduced bleeding (rho = −0.053), whereas TRA use across institutions was associated with reduced mortality (rho = −0.077). Conclusions Transradial access for STEMI PCI is increasing, but remains underutilized with significant geographic, operator, and institutional variation. These findings suggest an ongoing opportunity to standardize STEMI care.

AB - Objectives The study sought to define patient, operator, and institutional factors associated with transradial access (TRA) in ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding. Background TRA for PCI in STEMI is underutilized. Factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes. Methods The authors used hierarchical logistic regression to identify patient, operator, and institutional characteristics associated with TRA use as well as determine the variation in TRA for STEMI PCI from 2009 to 2015. They also described the relationship between operator- and institution-level use and risk-adjusted bleeding and mortality. Results Among 692,433 patients undergoing STEMI PCI, 12% (n = 82,618) utilized TRA. TRA increased from 2% to 23% from 2009 to 2015, but with significant geographic variation. Age, sex, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and nonacademically affiliated institutions were associated with lower rates of TRA. There was significant operator and institutional variation, wherein identical patients would have >8-fold difference in odds of TRA for STEMI PCI by changing operators (median odds ratio: 8.7), and >5-fold difference by changing institutions (median odds ratio: 5.1). Greater TRA use across operators was associated with reduced bleeding (rho = −0.053), whereas TRA use across institutions was associated with reduced mortality (rho = −0.077). Conclusions Transradial access for STEMI PCI is increasing, but remains underutilized with significant geographic, operator, and institutional variation. These findings suggest an ongoing opportunity to standardize STEMI care.

KW - mortality

KW - outcomes

KW - PCI

KW - STEMI

KW - transradial

UR - http://www.scopus.com/inward/record.url?scp=85032929382&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032929382&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2017.07.020

DO - 10.1016/j.jcin.2017.07.020

M3 - Article

VL - 10

SP - 2242

EP - 2254

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 22

ER -