학술논문
Relation of Operator Volume and Access Site to Short-Term Mortality in Radial Versus Femoral Access for Primary Percutaneous Coronary Intervention.
Document Type
Academic Journal
Author
Hannan EL; University at Albany, State University of New York, Albany, New York. Electronic address: edward.hannan@health.ny.gov.; Zhong Y; University at Albany, State University of New York, Albany, New York.; Ling FSK; University of Rochester Medical Center, Rochester, New York.; LeMay M; University of Ottawa Heart Institute, Ottawa, Canada.; Jacobs AK; Boston Medical Center, Boston, Massachusetts.; King SB; Emory Health System, Atlanta, Georgia.; Berger PB; Unaffiliated.; Venditti FJ; Albany Medical Center, Albany, New York.; Walford G; Johns Hopkins Medical Center, XXX, XXX.; Tamis-Holland J; Mount Sinai St. Luke's Hospital, New York, New York.
Source
Publisher: Excerpta Medica Country of Publication: United States NLM ID: 0207277 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1913 (Electronic) Linking ISSN: 00029149 NLM ISO Abbreviation: Am J Cardiol Subsets: MEDLINE
Subject
Language
English
Abstract
The relation between operator volume and mortality of primary percutaneous coronary intervention (PPCI) procedures for ST-elevation myocardial infarction has not been studied comprehensively. This study included patients who underwent PPCI between 2010 and 2017 in all nonfederal hospitals approved to perform PCI in New York State. We compared risk-adjusted in-hospital/30-day mortality for radial access (RA) and femoral access (FA) and the relation between risk-adjusted mortality and procedure volume for each access site. In 44,540 patients in the study period, the use of RA rose from 8% in 2,010% to 43% in 2017 (p <0.0001). There was no significant change in PPCI risk-adjusted mortality during the period (p=0.27 for trend). RA was associated with lower mortality when imposing operator exclusion criteria used in recent trials. There was a significant operator inverse volume-mortality relation for FA procedures but not for RA procedures. FA procedures performed by lower volume FA operators (lowest quartile) were associated with higher risk-adjusted mortality compared with RA procedures (3.71% vs 3.06%, p = 0.01) or compared with FA procedures performed by higher volume FA operators (3.71% vs 3.16%, p = 0.01). In conclusion, in patients with ST-elevation myocardial infarction referred for primary PCI in New York State, there was a significant uptake in the use of RA along with relatively constant in-hospital/30-day mortality. There was a significant inverse operator volume-mortality relation for FA procedures accompanied by higher mortality for FA procedures performed by low volume FA operators than for all other primary PCI procedures. In conclusion, this information underscores the need for operators to remain vigilant in maintaining FA skills and monitoring FA outcomes.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
(Copyright © 2022 Elsevier Inc. All rights reserved.)