The University of Southampton
University of Southampton Institutional Repository

Changes in arterial access site and association with mortality in the United Kingdom: observations from a National Percutaneous Coronary Intervention database

Changes in arterial access site and association with mortality in the United Kingdom: observations from a National Percutaneous Coronary Intervention database
Changes in arterial access site and association with mortality in the United Kingdom: observations from a National Percutaneous Coronary Intervention database

BACKGROUND: The transradial access (TRA) site has become the default access site for percutaneous coronary intervention in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use. This study evaluates regional changes in access site practice in England and Wales over time, examines whether changes in access site practice have been uniform nationally and across different patient subgroups, and provides national estimates for the potential number of lives saved or lost associated with regional differences in access site practice.

METHODS AND RESULTS: Using the British Cardiovascular Intervention Society database, we investigated outcomes for growth of TRA in different regions in England and Wales in 448 853 patients who underwent percutaneous coronary intervention from 2005 to 2012. Multiple logistic regression was used to quantify the effect of TRA on 30-day mortality and quantify lives saved and lost by differences in TRA adoption. TRA use increased from 14.0% to 58.6% in 417 038 PCI patients with large variations in different parts of the country. TRA was independently associated with a decreased risk of 30-day mortality (odds ratio=0.70; 95% confidence interval=0.66-0.74), with significant but small differences observed across different regions. The number of estimated lives saved was 450 (95% confidence interval=275-650), and we estimate that an additional 264 (95% confidence interval=153-399) lives would have been saved if TRA adoption were uniform nationally.

CONCLUSIONS: TRA has become the dominant percutaneous coronary intervention approach in the United Kingdom, with a wide variation in different parts of the country. Changes in practice have contributed to mortality reductions, and inequalities have resulted in missed opportunities for further improvements.

Databases, Factual/trends, Female, Femoral Artery/surgery, Humans, Male, Mortality/trends, Percutaneous Coronary Intervention/mortality, Radial Artery/surgery, United Kingdom/epidemiology
0009-7322
1655-1667
Mamas, Mamas A
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
de Belder, Mark A
3d0eff51-f1d1-41a7-aac1-e193db082360
Zaman, Azfar
1eb39d94-fdb9-466b-ab6c-7613255baf80
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Buchan, Iain
fe0050fa-9b04-40c5-8ef4-6574742b18e8
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Kontopantelis, Evangelos
0a21ca6f-4516-45f8-80fc-b10dd7db6780
British Cardiovascular Intervention Society (BCIS) and the National Institute for Clinical Outcomes Research (NICOR)
Mamas, Mamas A
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d
Nolan, James
1cdb1e12-958f-4b04-a730-242dd48591b1
de Belder, Mark A
3d0eff51-f1d1-41a7-aac1-e193db082360
Zaman, Azfar
1eb39d94-fdb9-466b-ab6c-7613255baf80
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Buchan, Iain
fe0050fa-9b04-40c5-8ef4-6574742b18e8
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Kontopantelis, Evangelos
0a21ca6f-4516-45f8-80fc-b10dd7db6780

British Cardiovascular Intervention Society (BCIS) and the National Institute for Clinical Outcomes Research (NICOR) (2016) Changes in arterial access site and association with mortality in the United Kingdom: observations from a National Percutaneous Coronary Intervention database. Circulation, 133 (17), 1655-1667. (doi:10.1161/CIRCULATIONAHA.115.018083).

Record type: Article

Abstract

BACKGROUND: The transradial access (TRA) site has become the default access site for percutaneous coronary intervention in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use. This study evaluates regional changes in access site practice in England and Wales over time, examines whether changes in access site practice have been uniform nationally and across different patient subgroups, and provides national estimates for the potential number of lives saved or lost associated with regional differences in access site practice.

METHODS AND RESULTS: Using the British Cardiovascular Intervention Society database, we investigated outcomes for growth of TRA in different regions in England and Wales in 448 853 patients who underwent percutaneous coronary intervention from 2005 to 2012. Multiple logistic regression was used to quantify the effect of TRA on 30-day mortality and quantify lives saved and lost by differences in TRA adoption. TRA use increased from 14.0% to 58.6% in 417 038 PCI patients with large variations in different parts of the country. TRA was independently associated with a decreased risk of 30-day mortality (odds ratio=0.70; 95% confidence interval=0.66-0.74), with significant but small differences observed across different regions. The number of estimated lives saved was 450 (95% confidence interval=275-650), and we estimate that an additional 264 (95% confidence interval=153-399) lives would have been saved if TRA adoption were uniform nationally.

CONCLUSIONS: TRA has become the dominant percutaneous coronary intervention approach in the United Kingdom, with a wide variation in different parts of the country. Changes in practice have contributed to mortality reductions, and inequalities have resulted in missed opportunities for further improvements.

This record has no associated files available for download.

More information

Accepted/In Press date: 19 February 2016
e-pub ahead of print date: 11 March 2016
Published date: 26 April 2016
Keywords: Databases, Factual/trends, Female, Femoral Artery/surgery, Humans, Male, Mortality/trends, Percutaneous Coronary Intervention/mortality, Radial Artery/surgery, United Kingdom/epidemiology

Identifiers

Local EPrints ID: 436088
URI: http://eprints.soton.ac.uk/id/eprint/436088
ISSN: 0009-7322
PURE UUID: 246b725b-b684-48d7-9e8a-f16c4add988b
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 27 Nov 2019 17:30
Last modified: 10 Jan 2022 02:50

Export record

Altmetrics

Contributors

Author: Mamas A Mamas
Author: James Nolan
Author: Mark A de Belder
Author: Azfar Zaman
Author: Tim Kinnaird
Author: Nick Curzen ORCID iD
Author: Chun Shing Kwok
Author: Iain Buchan
Author: Peter Ludman
Author: Evangelos Kontopantelis
Corporate Author: British Cardiovascular Intervention Society (BCIS) and the National Institute for Clinical Outcomes Research (NICOR)

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×