Procedural volume and outcomes with radial or femoral access for coronary angiography and intervention
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, multicentrická studie, randomizované kontrolované studie
PubMed
24269362
DOI
10.1016/j.jacc.2013.10.052
PII: S0735-1097(13)06022-1
Knihovny.cz E-zdroje
- Klíčová slova
- acute coronary syndrome(s), femoral access, percutaneous coronary intervention, procedural volume, radial access,
- MeSH
- akutní koronární syndrom diagnostické zobrazování chirurgie MeSH
- arteria femoralis MeSH
- arteria radialis MeSH
- koronární angiografie metody statistika a číselné údaje MeSH
- koronární angioplastika metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- periferní katetrizace metody statistika a číselné údaje MeSH
- prognóza MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
OBJECTIVES: The study sought to evaluate the relationship between procedural volume and outcomes with radial and femoral approach. BACKGROUND: RIVAL (RadIal Vs. femorAL) was a randomized trial of radial versus femoral access for coronary angiography/intervention (N = 7,021), which overall did not show a difference in primary outcome of death, myocardial infarction, stroke, or non-coronary artery bypass graft major bleeding. METHODS: In pre-specified subgroup analyses, the hazard ratios for the primary outcome were compared among centers divided by tertiles and among individual operators. A multivariable Cox proportional hazards model was used to determine the independent effect of center and operator volumes after adjusting for other variables. RESULTS: In high-volume radial centers, the primary outcome was reduced with radial versus femoral access (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.87) but not in intermediate- (HR: 1.23; 95% CI: 0.88 to 1.72) or low-volume centers (HR: 0.83; 95% CI: 0.52 to 1.31; interaction p = 0.021). High-volume centers enrolled a higher proportion of ST-segment elevation myocardial infarction (STEMI). After adjustment for STEMI, the benefit of radial access persisted at high-volume radial centers. There was no difference in the primary outcome between radial and femoral access by operator volume: high-volume operators (HR: 0.79; 95% CI: 0.48 to 1.28), intermediate (HR: 0.87; 95% CI: 0.60 to 1.27), and low (HR: 1.10; 95% CI: 0.74 to 1.65; interaction p = 0.536). However, in a multivariable model, overall center volume and radial center volume were independently associated with the primary outcome but not femoral center volume (overall percutaneous coronary intervention volume HR: 0.92, 95% CI: 0.88 to 0.96; radial volume HR: 0.88, 95% CI: 0.80 to 0.97; and femoral volume HR: 1.00, 95% CI: 0.94 to 1.07; p = 0.98). CONCLUSIONS: Procedural volume and expertise are important, particularly for radial percutaneous coronary intervention. (A Trial of Trans-radial Versus Trans-femoral Percutaneous Coronary Intervention [PCI] Access Site Approach in Patients With Unstable Angina or Myocardial Infarction Managed With an Invasive Strategy [RIVAL]; NCT01014273).
Charles University Hospital Kralovske Vinohrady Prague Czech Republic
Skane University Hospital Lund Sweden
Southlake Regional Health Centre University of Toronto Ontario Canada
St Michael's Hospital University of Toronto Ontario Canada
Tampere University Hospital and Heart Center Tampere Finland
Université Paris Diderot Paris France
University of Adelaide Royal Adelaide Hospital Adelaide Australia
University of British Columbia Vancouver British Columbia Canada
Citace poskytuje Crossref.org
ClinicalTrials.gov
NCT01014273
