Author + information
- Received March 24, 2017
- Revision received May 26, 2017
- Accepted July 2, 2017
- Published online November 20, 2017.
- Javier A. Valle, MD, MSCSa,
- Lisa A. Kaltenbach, MSb,
- Steven M. Bradley, MD, MPHc,
- Robert W. Yeh, MD, MScd,
- Sunil V. Rao, MDe,
- Hitinder S. Gurm, MDf,
- Ehrin J. Armstrong, MD, MSca,g,
- John C. Messenger, MDa and
- Stephen W. Waldo, MDa,g,∗ ()
- aDivision of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
- bDuke Cardiovascular Research Institute, Durham, North Carolina
- cMinneapolis Heart Institute, Minneapolis, Minnesota
- dSmith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- eDivision of Cardiology, Duke University School of Medicine, Durham, North Carolina
- fDivision of Cardiovascular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
- gSection of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
- ↵∗Address for correspondence:
Dr. Stephen W. Waldo, Section of Cardiology, Veterans Affairs Eastern Colorado Health Care System, 1055 Clermont Drive, Denver, Colorado 80220.
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.
The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. Dr. Rao has served as a consultant for Medtronic. Dr. Gurm has served as a consultant for Osprey Medical; and has received research funding from the National Institutes of Health. Dr. Armstrong has served as a consultant or on the advisory board for Abbott Vascular, Boston Scientific, Cardiovascular Systems, and Spectranetics. Dr. Waldo has received research grants from Abiomed, Cardiovascular Systems, and Merck Pharmaceuticals to the Denver Research Institute. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 24, 2017.
- Revision received May 26, 2017.
- Accepted July 2, 2017.
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