Is There a Relationship of Operator and Center Volume With Access Site-Related Outcomes?: An Analysis From the British Cardiovascular Intervention Society

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

doi:10.1161/CIRCINTERVENTIONS.115.003333

Is There a Relationship of Operator and Center Volume With Access Site-Related Outcomes? An Analysis From the British Cardiovascular Intervention Society

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

Research output: Contribution to journal › Article › peer-review

192 Downloads (Pure)

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.

Original language	English
Article number	e003333
Journal	Circulation: Cardiovascular Interventions
Volume	9
Issue number	5
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.115.003333
Publication status	Published - May 2016

Research Beacons, Institutes and Platforms

Dementia@Manchester

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1161/CIRCINTERVENTIONS.115.003333

Radial volume manuscriptAccepted author manuscript, 5.41 MB

Cite this

Hulme, W., Sperrin, M., Rushton, H., Ludman, P. F., De Belder, M., Curzen, N., Kinnaird, T., Kwok, C. S., Buchan, I., Nolan, J., & Mamas, M. 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), Article e003333. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003333

@article{1125173fb77d4f1186cfe4936cfc00f6,

title = "Is There a Relationship of Operator and Center Volume With Access Site-Related Outcomes?: An Analysis From the British Cardiovascular Intervention Society",

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.",

author = "William Hulme and Matthew Sperrin and Helen Rushton and Ludman, {Peter F} and {De Belder}, Mark and Nick Curzen and Tim Kinnaird and Kwok, {Chun Shing} and Iain Buchan and James Nolan and Mamas, {Mamas A}",

note = "{\textcopyright} 2016 American Heart Association, Inc.",

year = "2016",

month = may,

doi = "10.1161/CIRCINTERVENTIONS.115.003333",

language = "English",

volume = "9",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "5",

}

Hulme, W, Sperrin, M, Rushton, H, Ludman, PF, De Belder, M, Curzen, N, Kinnaird, T, Kwok, CS, Buchan, I, Nolan, J & Mamas, MA 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, vol. 9, no. 5, e003333. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003333

TY - JOUR

T1 - Is There a Relationship of Operator and Center Volume With Access Site-Related Outcomes?

T2 - An Analysis From the British Cardiovascular Intervention Society

AU - Hulme, William

AU - Sperrin, Matthew

AU - Rushton, Helen

AU - Ludman, Peter F

AU - De Belder, Mark

AU - Curzen, Nick

AU - Kinnaird, Tim

AU - Kwok, Chun Shing

AU - Buchan, Iain

AU - Nolan, James

AU - Mamas, Mamas A

PY - 2016/5

Y1 - 2016/5

N2 - 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.

AB - 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.

U2 - 10.1161/CIRCINTERVENTIONS.115.003333

DO - 10.1161/CIRCINTERVENTIONS.115.003333

M3 - Article

C2 - 27162213

SN - 1941-7640

VL - 9

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 5

M1 - e003333

ER -