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Is there a relationship of operator and center volume with access site-related outcomes?: An analysis from the British Cardiovascular Intervention Society

Is there a relationship of operator and center volume with access site-related outcomes?: An analysis from the British Cardiovascular Intervention Society
Is there a relationship of operator and center volume with access site-related outcomes?: An analysis from the British Cardiovascular Intervention Society

BACKGROUND: Transradial access is associated with reduced access site-related bleeding complications and mortality post percutaneous coronary intervention. The objective of this study is to examine the relationship between access site practice and clinical outcomes and how this may be influenced by operator and center experience/expertise.

METHODS AND RESULTS: The influence of operator and center experience/expertise was studied on 30-day mortality, in-hospital major adverse cardiovascular events (a composite of in-hospital mortality and in-hospital myocardial infarction and target vessel revascularization) and in-hospital major bleeding based on access site adopted (radial versus femoral). Operator/center experience/expertise were defined by both total volume and transradial access proportion. A total of 164 395 procedures between 2012 and 2013 in the National Health Service in England and Wales were analyzed. After case-mix adjustment, transradial access was associated with an average odds reduction of 39% for 30-day mortality compared with transfemoral access (odds ratio, 0.61; 95% confidence interval, 0.55-0.68; P<0.001). The magnitude of this risk reduction was modified by increases in total procedural volume and radial proportion at the operator level (odds ratio reduction of 11% per 100 extra procedures, 95% confidence interval, 3%-19%; odds ratio reduction of 6% per 10%-point increase in radial proportion, 95% confidence interval, 1%-11%) with no significant impact of operator radial volume, center total volume, center radial volume, and center radial proportion.

CONCLUSIONS: The lower mortality associated with transradial access adoption relates to both the total procedural volume and the proportion of procedures undertaken radially by operator, with operators undertaking the greatest proportion of their procedures radially having the largest relative reduction in mortality risk.

Aged, Female, Hospitals, Humans, Male, Middle Aged, Myocardial Infarction/epidemiology, Percutaneous Coronary Intervention, Postoperative Hemorrhage/epidemiology, Professional Practice, Risk, Survival Analysis, Treatment Outcome, United Kingdom
1941-7640
Hulme, William
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Sperrin, Matthew
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Rushton, Helen
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Ludman, Peter F.
ed96bc44-311b-4a55-88d9-ce83bab3e791
De Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Curzen, Nick
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Kinnaird, Tim
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Kwok, Chun Shing
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Buchan, Iain
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Nolan, James
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Mamas, Mamas A.
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Hulme, William
9bfbc023-25cf-4d34-94f3-f06eb932e312
Sperrin, Matthew
e1dd5334-ed19-48c7-b486-024fb03330ba
Rushton, Helen
224011d4-4d9b-4669-b97c-53ae0e743635
Ludman, Peter F.
ed96bc44-311b-4a55-88d9-ce83bab3e791
De Belder, Mark
f0106dad-a7dd-4c54-a47e-03ec4c5c826f
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kinnaird, Tim
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Kwok, Chun Shing
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Buchan, Iain
fe0050fa-9b04-40c5-8ef4-6574742b18e8
Nolan, James
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Mamas, Mamas A.
b71e6a0a-07a4-4822-a10e-c02a6b29ae5d

Hulme, William, Sperrin, Matthew, Rushton, Helen, Ludman, Peter F., De Belder, Mark, Curzen, Nick, Kinnaird, Tim, Kwok, Chun Shing, Buchan, Iain, Nolan, James and Mamas, Mamas A. (2016) Is there a relationship of operator and center volume with access site-related outcomes?: An analysis from the British Cardiovascular Intervention Society. Circulation. Cardiovascular interventions, 9 (5), [e003333]. (doi:10.1161/CIRCINTERVENTIONS.115.003333).

Record type: Article

Abstract

BACKGROUND: Transradial access is associated with reduced access site-related bleeding complications and mortality post percutaneous coronary intervention. The objective of this study is to examine the relationship between access site practice and clinical outcomes and how this may be influenced by operator and center experience/expertise.

METHODS AND RESULTS: The influence of operator and center experience/expertise was studied on 30-day mortality, in-hospital major adverse cardiovascular events (a composite of in-hospital mortality and in-hospital myocardial infarction and target vessel revascularization) and in-hospital major bleeding based on access site adopted (radial versus femoral). Operator/center experience/expertise were defined by both total volume and transradial access proportion. A total of 164 395 procedures between 2012 and 2013 in the National Health Service in England and Wales were analyzed. After case-mix adjustment, transradial access was associated with an average odds reduction of 39% for 30-day mortality compared with transfemoral access (odds ratio, 0.61; 95% confidence interval, 0.55-0.68; P<0.001). The magnitude of this risk reduction was modified by increases in total procedural volume and radial proportion at the operator level (odds ratio reduction of 11% per 100 extra procedures, 95% confidence interval, 3%-19%; odds ratio reduction of 6% per 10%-point increase in radial proportion, 95% confidence interval, 1%-11%) with no significant impact of operator radial volume, center total volume, center radial volume, and center radial proportion.

CONCLUSIONS: The lower mortality associated with transradial access adoption relates to both the total procedural volume and the proportion of procedures undertaken radially by operator, with operators undertaking the greatest proportion of their procedures radially having the largest relative reduction in mortality risk.

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More information

Accepted/In Press date: 21 March 2016
e-pub ahead of print date: 9 May 2016
Published date: May 2016
Keywords: Aged, Female, Hospitals, Humans, Male, Middle Aged, Myocardial Infarction/epidemiology, Percutaneous Coronary Intervention, Postoperative Hemorrhage/epidemiology, Professional Practice, Risk, Survival Analysis, Treatment Outcome, United Kingdom

Identifiers

Local EPrints ID: 436144
URI: http://eprints.soton.ac.uk/id/eprint/436144
ISSN: 1941-7640
PURE UUID: 6e09d21a-4d0a-45b7-9143-07b5b3aafa3f
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 29 Nov 2019 17:30
Last modified: 08 Jun 2022 01:39

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Contributors

Author: William Hulme
Author: Matthew Sperrin
Author: Helen Rushton
Author: Peter F. Ludman
Author: Mark De Belder
Author: Nick Curzen ORCID iD
Author: Tim Kinnaird
Author: Chun Shing Kwok
Author: Iain Buchan
Author: James Nolan
Author: Mamas A. Mamas

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