Terrence Donnelly Heart Center, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
Circ Cardiovasc Interv. 2011 Aug;4(4):336-41. doi: 10.1161/CIRCINTERVENTIONS.110.960864. Epub 2011 Aug 2.
Transradial percutaneous coronary intervention (TR-PCI) improves clinical outcomes compared to the transfemoral (TF) approach. However, inadequate training and experience has limited widespread adoption by interventional cardiologists.
Clinical and procedural characteristics for TR-PCI were prospectively collected from 1999 to 2008. To identify minimum case volume for optimum clinical benefit, single-vessel TR-PCI cases were chronologically ranked and stratified into 1 to 50, 51 to 100, 101 to 150 and 151 to 300 case volume groups for operators starting the TR approach at the study institution. Cases by operators with a >300 TR-PCI case volume comprised the control group. TR-PCI failure rates, contrast use, guide usage, and fluoroscopy time were compared among groups. A total of 1672 patients underwent TR-PCI by 28 operators. TR-PCI failure occurred in 4% and was higher in the 1 to 50 case volume group compared to the 51 to 100 (P=0.007) and control (P=0.01) groups. Contrast use was greater in the 1 to 50 group (180±79 mL) compared to the 151 to 300 (157±75 mL, P=0.02) and control (168±79 mL, P=0.05) groups. Fluoroscopy time was higher in the 1 to 50 group (15±10 minutes) compared to the 101 to 150 (13±10 minutes, P=0.04) and control (12±9 minutes, P=0.02) groups. Reasons for TR-PCI failure included spasm (38%), subclavian tortuousity (16%), poor guide support (16%), failed access (10%), and radial loop (7%). Case volume was significantly correlated with TR-PCI failure (β=-0.0076, P=0.0028), and odds of failure was reduced by 32% for each 50 increments in case volume.
TR-PCI success depends on operator experience, and a case volume of ≥50 cases is required to achieve outcomes comparable to experienced operators. These findings have implications both for PCI operators looking to expand their skills and for defining standards for training.
与经股动脉（TF）入路相比，经桡动脉（TR）经皮冠状动脉介入治疗（PCI）可改善临床结局。然而，介入心脏病专家因培训和经验不足而限制了其广泛应用。
从 1999 年至 2008 年，前瞻性收集了 TR-PCI 的临床和手术特征。为了确定最佳临床获益的最小病例量，按时间顺序对单支血管 TR-PCI 病例进行排名，并将起始 TR 入路的术者分为 1-50、51-100、101-150 和 151-300 例量组。术者>300 例 TR-PCI 病例量的病例归入对照组。比较不同组间 TR-PCI 失败率、造影剂使用、导引导管使用和透视时间。共有 1672 例患者由 28 名术者行 TR-PCI。4%的患者发生 TR-PCI 失败，1-50 例量组的失败率高于 51-100 例量组（P=0.007）和对照组（P=0.01）。1-50 例量组造影剂用量（180±79mL）大于 151-300 例量组（157±75mL，P=0.02）和对照组（168±79mL，P=0.05）。1-50 例量组透视时间（15±10 分钟）长于 101-150 例量组（13±10 分钟，P=0.04）和对照组（12±9 分钟，P=0.02）。TR-PCI 失败的原因包括痉挛（38%）、锁骨下迂曲（16%）、导引导管支持不良（16%）、入路失败（10%）和桡动脉环（7%）。病例量与 TR-PCI 失败显著相关（β=-0.0076，P=0.0028），病例量每增加 50 例，失败的可能性降低 32%。
TR-PCI 的成功取决于术者经验，需要≥50 例病例量才能获得与经验丰富的术者相当的结果。这些发现不仅对希望扩展技能的 PCI 术者有意义，而且对培训标准的定义也有意义。
