Changes in arterial access site and association with mortality in the United Kingdom: observations from a national percutaneous coronary intervention database

Abstract

Background The transradial access (TRA) site has become the default access site for PCI in the UK with randomized trials and national registry data showing reductions in mortality associated with TRA utilization. This study evaluates regional changes in access site practice in England and Wales over time and whether changes in access site practice has been uniform nationally and across different patient sub-groups, and provide national estimates for the potential number of lives ‘saved’ or ‘lost’ associated with regional differences in access site practice. Methods and Results Using the BCIS (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 PCI, 2005-2012. Multiple logistic regressions used to quantify the effect of TRA on 30-day mortality and quantify lives ‘saved’ and ‘lost’ by differences in TRA adoption. TRA utilization 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 (OR=0·70; 95%CI=0·66-0·74) with significant but small differences observed across different regions. The number of estimated lives ‘saved’ was 450 (95%CI=275-650) and estimate that an additional 264 (95%CI=153-399) lives would have been saved if TRA adoption were uniform nationally. Conclusions TRA has become the dominant PCI approach in the UK with a wide variation in different parts of the country. Changes in practice have contributed to mortality reductions, whilst inequalities have resulted in missed opportunities for further improvements.