Author + information
- Daniel W. Nelson1,
- Abdulla Damluji2,
- Nish Patel3,
- Marco Valgimigli4,
- Stephan Windecker4,
- Robert Byrne5,
- James Nolan6,
- Tejas Patel7,
- Emmanouil Brilakis8,
- Subhash Banerjee9,
- Jorge Mayol10,
- Warren Cantor11,
- Carlos Alfonso3,
- Sunil Rao12,
- Mauro Moscucci2 and
- Mauricio Cohen3
- 1Medical College of Wisconsin, Mequon, WI
- 2Sinai Hospital of Baltimore, Baltimore, MD
- 3University of Miami, Miami, FL
- 4Swiss Cardiovascular Center, Bern, Switzerland
- 5Deutsches Herzzentrum Munchen, Munich, Germany
- 6University Hospitals of North Midlands, Stoke, United Kingdom
- 7Apex Heart Institute, Ahmedabad, India
- 8Minneapolis Heart Institute, Minneapolis, MN
- 9University of Texas Southwestern, Dallas, TX
- 10Centro Cardiologico Americano, Montevideo, Uruguay
- 11Southlake Regional Health Center, Toronto, ON, Canada
- 12Duke Clinical Research Institute, Durham, NC
Transfemoral access (TFA) is widely used for coronary angiography and percutaneous coronary intervention (PCI). The influence of operator experience and PCI volume on adherence to transfemoral access best practices has not been studied. This international survey aimed to examine the influence of operator experience on TFA practices and fill important gaps to improve the quality of care in the cardiac catheterization laboratory.
A survey instrument was developed and distributed via email from professional societies to interventional cardiologists worldwide between March and December 2016.
A total of 988 physicians from 88 countries responded to the survey. TFA is the preferred approach for patients with cardiogenic shock, left main or bifurcation PCI, and procedures with mechanical circulatory support. Older (<50 years: 56.4%; ≥50 years: 66.8%, p < 0.0039) and high PCI volume operators (<100 PCI: 57.3%; 100-299 PCI: 58.7%; ≥300 PCI: 64.3%, p < 0.134) utilize palpation alone without imaging (fluoroscopy or ultrasound) for TFA (Figure). Most respondents do not use micropuncture needle to gain arterial access regardless of age or experience. Older operators (<50 years: 71.5%; ≥50 years: 64.4%, p < 0.04) and high PCI volume operators (<100 PCI: 67.9%; 100-299 PCI: 72.6%; ≥300 PCI: 64.1%, p < 0.072) are less likely to perform a femoral angiogram (FA) during PCI. Of those performing FA, the majority (67%) does so at the end of the procedure.
Despite best-practice guideline recommendations, older and high PCI volume interventional cardiologists prefer not to use imaging (fluoroscopy or ultrasound) for femoral access or to perform femoral angiography during TF PCI. Future studies should investigate whether the lack of adoption of best practices in TFA is associated with adverse events.