Cardiology 2013. Part II.
March 9, 2014
Journal: Ugeskr Laeger
Date: Feb 4
Short Title: [PCI should be decentralized. The National Board of Health and the Danish Society of Cardiology ought to take the debate]
Alternate Journal: Ugeskrift for laeger
ISSN: 1603-6824 (Electronic)
Original Publication: PCI skal decentraliseres. Sundhedsstyrelsen og Dansk Cardiologisk Selskab bor tage debatten.
Accession Number: 23530280
Keywords: *Angioplasty, Balloon, Coronary
*Cardiology Service, Hospital
Notes: Bagger, Henning
Ugeskr Laeger. 2013 Feb 4;175(6):380.
Reference Type: Journal Article
Record Number: 980Author: Balwanz, C. R., Javed, U., Singh, G. D., Armstrong, E. J., Southard, J. A., Wong, G. B., Yeo, K. K., Low, R. I., Laird, J. R., Jr. and Rogers, J. H.
Title: Transradial and transfemoral coronary angiography and interventions: 1-year outcomes after initiating the transradial approach in a cardiology training program
Journal: Am Heart J
Short Title: Transradial and transfemoral coronary angiography and interventions: 1-year outcomes after initiating the transradial approach in a cardiology training program
Alternate Journal: American heart journal
ISSN: 1097-6744 (Electronic)
Accession Number: 23453098
Coronary Angiography/adverse effects/*methods
Percutaneous Coronary Intervention/adverse effects/*methods
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.