Division of Cardiology, Medical University of South Carolina, Charleston, USA.
Am J Cardiol. 2012 Apr 15;109(8):1154-9. doi: 10.1016/j.amjcard.2011.11.048. Epub 2012 Jan 14.
This study sought to examine the safety of percutaneous coronary intervention (PCI) before and during de novo establishment of a transradial (TR) program at a teaching hospital. TR access remains underused in the United States, where cardiology fellowship programs continue to produce cardiologists with little TR experience. Establishment of TR programs at teaching hospitals may affect PCI safety. Starting in July 2009 a TR program was established at a teaching hospital. PCI-related data for academic years 2008 to 2009 (Y1) and 2009 to 2010 (Y2) were prospectively collected and retrospectively analyzed. Of 1,366 PCIs performed over 2 years, 0.1% in Y1 and 28.7% in Y2 were performed by TR access. No major complications were identified in 194 consecutive patients undergoing TR PCI, and combined bleeding and vascular complication rates were lower in Y2 versus Y1 (0.7% vs 2.0%, p = 0.05). Patients treated in Y2 versus Y1 and by TR versus transfemoral approach required slightly more fluoroscopy but similar contrast volumes and had similar procedural durations, lengths of stay, and predischarge mortality rates. PCI success rates were 97% in Y1, 97% in Y2, and 98% in TR cases. TR PCIs were performed by 13 cardiology fellows and 9 attending physicians, none of whom routinely performed TR PCI previously. In conclusion, de novo establishment of a TR program improved PCI safety at a teaching hospital. TR programs are likely to improve PCI safety at other teaching hospitals and should be established in all cardiology fellowship training programs.
本研究旨在探讨在一所教学医院新建立经桡动脉（TR）入路程序前后行经皮冠状动脉介入治疗（PCI）的安全性。在美国，TR 入路的使用率仍然较低，而心血管病学 fellowship 项目仍在培养 TR 经验较少的心血管病专家。教学医院建立 TR 项目可能会影响 PCI 的安全性。自 2009 年 7 月起，一所教学医院开始建立 TR 项目。前瞻性收集并回顾性分析了 2008 年至 2009 年（Y1）和 2009 年至 2010 年（Y2）学术年的 PCI 相关数据。在 2 年期间进行的 1366 例 PCI 中，Y1 中有 0.1%，Y2 中有 28.7%是通过 TR 入路进行的。在 194 例连续接受 TR PCI 的患者中，未发现重大并发症，Y2 中联合出血和血管并发症发生率低于 Y1（0.7%对 2.0%，p = 0.05）。与 Y1 相比，Y2 中接受治疗的患者以及接受 TR 与经股动脉入路的患者需要稍微更多的透视，但透视剂量、造影剂用量、手术时间、住院时间和出院前死亡率相似。Y1 的 PCI 成功率为 97%，Y2 为 97%，TR 病例为 98%。TR PCI 由 13 名心脏病学研究员和 9 名主治医生进行，他们之前均无常规进行 TR PCI 的经验。总之，新建立 TR 项目可提高教学医院 PCI 的安全性。TR 项目可能会提高其他教学医院 PCI 的安全性，并且应该在所有心血管病学 fellowship培训项目中建立。
