Keele Research Repository

Background: Transradial access (TRA) is associated with reduced access site related bleeding complications and mortality post percutaneous coronary intervention (PCI). 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 MACE (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 vs femoral). Operator/center experience/expertise were defined by both total volume and TRA proportion. A total of 164,395 procedures between 2012 and 2013 in the NHS in England and Wales were analyzed. After case-mix adjustment, TRA was associated with an average odds reduction of 39% for 30-day mortality compared with transfemoral access (TFA) (OR = 0.61, 95% CI 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 (OR reduction of 11% per 100 extra procedures, 95% CI 3-19%; OR reduction of 6% per 10%-point increase in radial proportion, 95% CI 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 TRA 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.