Author + information
- Received March 13, 2019
- Revision received May 1, 2019
- Accepted May 28, 2019
- Published online August 28, 2019.
- David Kopin, MDa,
- Milan Seth, MSa,
- Devraj Sukul, MD, MSa,
- Simon Dixon, MBChBb,
- Herbert D. Aronow, MD, MPHc,
- Daniel Lee, MDd,
- Michael Tucciarone, MDb,
- Elizabeth Pielsticker, MDe and
- Hitinder S. Gurm, MBBSa,∗ ()
- aDivision of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- bDepartment of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan
- cCardiovascular Institute, Alpert Medical School at Brown University, Providence, Rhode Island
- dDepartment of Internal Medicine, McLaren Health Care, Bay City, Michigan
- eDepartment of Internal Medicine, Michigan Heart, Saint Joseph Mercy Health System, Jackson, Michigan
- ↵∗Address for correspondence:
Dr. Hitinder S. Gurm, University of Michigan Frankel Cardiovascular Center, 2A 192 F, 1500 East Medical Drive, Ann Arbor, Michigan 48109-5853.
Objectives The study sought to describe the association between trends in primary and secondary vascular access sites and vascular access site complications (VASCs) among patients who underwent percutaneous coronary intervention (PCI) in Michigan.
Background The frequency of transradial PCI has increased. As a result, there is concern that operators may lose femoral-access proficiency resulting in a paradoxical increase in PCI complications. Anecdotally, an increase in secondary access use during PCI has also been observed.
Methods Data from the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry was queried to evaluate the use of transradial and transfemoral PCI and their associated VASCs.
Results From 2013 to 2017, transradial PCI increased from 25.9% to 45.2% and the overall use of secondary vascular access increased from 4.9% to 8.7% with minimal change in overall VASCs (1.2% to 1.4%). The use of secondary vascular access was associated with increased VASCs (odds ratio [OR]: 5.82; 95% confidence interval [CI]: 5.26 to 6.43). Although, patients treated by operators in the highest tertile of radial use were more likely to experience femoral VASCs (adjusted OR: 1.51; 95% CI: 1.08 to 2.13), treatment by these operators was associated with an overall reduction in all VASCs (adjusted OR: 0.62; 95% CI: 0.46 to 0.83).
Conclusions Despite increased use of transradial PCI, there has been no significant decrease in VASCs. This is in part attributable to an increased incidence of femoral VASCs and increasing use of secondary vascular access. An overall reduction in VASCs was observed in the highest radial use operators. Further strategies are needed to reduce VASCs in the transradial era.
This work was supported by the Blue Cross Blue Shield of Michigan and Blue Care Network as part of the Blue Cross Blue Shield of Michigan Value Partnerships program. The funding source supported data collection at each site and funded the data-coordinating center but had no role in study concept, interpretation of findings, or in the preparation, final approval or decision to submit the manuscript. Although Blue Cross Blue Shield of Michigan and BMC2 work collaboratively, the opinions, beliefs, and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs, and viewpoints of Blue Cross Blue Shield of Michigan or any of its employees. Dr. Sukul was supported by a National Institutes of Health T32 postdoctoral research training grant (T32-HL007853). Dr. Gurm was supported by the National Institutes of Health Center for Centers for Accelerated Innovation, and Blue Cross Blue Shield of Michigan; and has served as a consultant for Osprey Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 13, 2019.
- Revision received May 1, 2019.
- Accepted May 28, 2019.
- 2019 American College of Cardiology Foundation
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