United Kingdom Study Evaluates Changes in Arterial Access Site and Association With Mortality

May 2, 2016—A United Kingdom study of the changes in arterial access site for percutaneous coronary intervention (PCI) and the association with mortality was published by Mamas A. Mamas, BM BCh, DPhil, et al on behalf of the British Cardiovascular Intervention Society and the National Institute for Clinical Outcomes Research in Circulation (2016;133:1655–1667).

The background of the study is that the transradial access (TRA) site has become the default access site for PCI in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use.

In this study, the investigators evaluated regional changes in access site practice in England and Wales over time, examined whether changes in access site practice have been uniform nationally and across different patient subgroups, and provided national estimates for the potential number of lives saved or lost associated with regional differences in access site practice.

The investigators found that TRA has become the dominant approach for PCI in the United Kingdom, but with a wide variation in different parts of the country. They concluded that changes in practice have contributed to mortality reductions and inequalities have resulted in missed opportunities for further improvements.

As summarized in Circulation, the investigators used the British Cardiovascular Intervention Society database to evaluate outcomes for the growth of TRA in different regions in England and Wales in 448,853 patients who underwent PCI 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% to 58.6% in 417,038 patients with PCI, with large variations in different parts of the country. They found that TRA was independently associated with a decreased risk of 30-day mortality, with significant but small differences observed across different regions. The number of estimated lives saved was 450, and they estimated that an additional 264 lives would have been saved if TRA adoption were uniform nationally, reported the investigators in Circulation.