Procedural volume and outcomes with radial or femoral access for coronary angiography and intervention
| Autor: | Rival Investigators, Warren J. Cantor, Matthew I. Worthley, Philippe Gabriel Steg, Göran K. Olivecrona, Sanjit S. Jolly, Nicholas Valettas, Michael Rokoss, Salim Yusuf, Petr Widimsky, Peggy Gao, John A. Cairns, Kari Niemelä, Shamir R. Mehta, Emile Ferrari, Asim N. Cheema, Anthony Fung |
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| Rok vydání: | 2013 |
| Předmět: |
Male
acute coronary syndrome(s) medicine.medical_specialty medicine.medical_treatment Coronary Angiography femoral access Percutaneous Coronary Intervention Internal medicine Catheterization Peripheral medicine Humans Myocardial infarction Acute Coronary Syndrome Stroke Aged radial access Proportional hazards model business.industry Unstable angina Hazard ratio Percutaneous coronary intervention Middle Aged medicine.disease Prognosis Confidence interval Surgery Femoral Artery Conventional PCI Radial Artery Cardiology procedural volume Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American College of Cardiology. 63(10) |
| ISSN: | 1558-3597 |
| Popis: | 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) (C) 2014 by the American College of Cardiology Foundation (Less) |
| Databáze: | OpenAIRE |
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