Variations Evaluated in the Adoption of Transradial Access for STEMI Patients Undergoing PCI
November 27, 2017—Findings from a study on variations in the adoption of transradial access (TRA) for ST-segment elevation myocardial infarction (STEMI) were published by Javier A. Valle, MD, et al online in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.
Using data from the National Cardiovascular Data Registry CathPCI Registry, the study sought to define patient, operator, and institutional factors associated with TRA in STEMI percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding.
According to the investigators, TRA for PCI in STEMI is underutilized; additionally, factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes.
As summarized in JACC: Cardiovascular Interventions, the investigators used hierarchical logistic regression to identify patient, operator, and institutional characteristics associated with TRA use and to determine the variation in TRA for STEMI PCI from 2009 to 2015. They also described the relationship between operator- and institution-level use and risk-adjusted bleeding and mortality.
The investigators reported that among 692,433 patients undergoing STEMI PCI, 12% (n = 82,618) utilized TRA. TRA increased from 2% to 23% from 2009 to 2015, but with significant geographic variation. Age, sex, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and nonacademically affiliated institutions were associated with lower rates of TRA.
There was significant operator and institutional variation, wherein identical patients would have a greater than eightfold difference in odds of TRA for STEMI PCI by changing operators (median odds ratio, 8.7), and a greater than fivefold difference by changing institutions (median odds ratio, 5.1). Greater TRA use across operators was associated with reduced bleeding (rho = −0.053), whereas TRA use across institutions was associated with reduced mortality (rho = −0.077).
From these findings, the investigators concluded that TRA for STEMI PCI is increasing, but remains underutilized with significant geographic, operator, and institutional variation. These findings suggest an ongoing opportunity to standardize STEMI care, noted the investigators in JACC: Cardiovascular Interventions.