Division of Cardiovascular Medicine, University of California, Sacramento, CA, USA.
Am Heart J. 2013 Mar;165(3):310-6. doi: 10.1016/j.ahj.2012.10.014. Epub 2012 Nov 17.
Limited data are available regarding the safety and feasibility of initiating transradial (TR) diagnostic coronary angiography (CA) and percutaneous coronary intervention (PCI) in cardiology fellowship programs.
From July 2010 to June 2011, University of California, Davis Medical Center, adopted the TR approach with supervised cardiology fellows as the primary operators. Procedural variables and clinical outcomes of TR and transfemoral (TF) procedures were compared. To minimize confounding variables, ST-elevation myocardial infarction, bypass graft interventions, chronic total occlusions, and procedures with concomitant right heart catheterizations were excluded. To reflect the learning curve of the TR approach, this experience was assessed in 2 sequential 6-month periods.
A total of 402 diagnostic CAs and 255 PCIs were included. Transradial access was used in 141 (35%) of the CAs and in 72 (28%) of PCIs. Within the TR-CA and TF-CA (n = 261) groups, there was no difference between fluoroscopy (10.4 ± 6.0 vs 11.0 ± 8.9, P = .63) or procedure (31.8 ± 11.5 vs 33.2 ± 13.8, P = .55) time throughout the academic year with a significant trend toward lower contrast use (128 ± 52 vs 110 vs 50, P = .04) by the second half. In addition, during the second half of the academic year, the TR-CA showed significantly higher fluoroscopy (11.0 ± 8.9 vs 6.7 ± 6.8, P = .001) and procedure (33.2 ± 13.8 vs 27.2 ± 11.6, P = .0015) times when compared with TF-CA. Transfemoral PCI (n = 183) and TR-PCI showed no significant difference between all fluoroscopy and procedure time and contrast use when comparing the 2 halves of the academic year. When comparing TF with TR within each academic half year, there was no difference within the PCI group. Vascular complications were less with the TR approach. Overall procedural success rates were high, and there were low rates of crossover and periprocedural complications in both the TR and the TF groups.
A TR approach is safe for CA and PCI when performed by supervised operators in training. Although the learning curve for trainees appears slower for TR-CA compared with TF-CA, cardiology fellowship training programs should be encouraged to adopt TR procedures as part of their curriculum.
关于在心脏病学住院医师培训计划中开始经桡动脉（TR）诊断性冠状动脉造影（CA）和经皮冠状动脉介入治疗（PCI）的安全性和可行性，数据有限。
从 2010 年 7 月至 2011 年 6 月，加利福尼亚大学戴维斯医学中心采用 TR 方法，由监督心脏病学研究员作为主要操作者。比较 TR 和经股（TF）程序的程序变量和临床结果。为了最小化混杂变量，排除了 ST 段抬高型心肌梗死、旁路移植术、慢性完全闭塞和同时进行右心导管插入术的程序。为了反映 TR 方法的学习曲线，在 2 个连续的 6 个月期间评估了这一经验。
共纳入 402 例诊断性 CA 和 255 例 PCI。在 141 例 CA（35%）和 72 例 PCI（28%）中采用了 TR 入路。在 TR-CA 和 TF-CA（n=261）组中，整个学年透视（10.4±6.0 与 11.0±8.9，P=0.63）或手术（31.8±11.5 与 33.2±13.8，P=0.55）时间无差异，但在第二学期有使用造影剂减少的明显趋势（128±52 与 110±50，P=0.04）。此外，在学年的后半学期，TR-CA 的透视（11.0±8.9 与 6.7±6.8，P=0.001）和手术（33.2±13.8 与 27.2±11.6，P=0.0015）时间明显长于 TF-CA。与 TF-CA 相比，TR-PCI（n=183）和 TF-PCI 在比较两个学期的透视和手术时间以及造影剂使用时，没有显示出显著差异。在每个学年的上半年，将 TF 与 TR 进行比较时，PCI 组没有差异。TR 方法的血管并发症较少。总体手术成功率较高，TR 和 TF 组的交叉和围手术期并发症发生率较低。
在接受监督的培训医生进行时，TR 方法是安全的，可用于 CA 和 PCI。尽管与 TF-CA 相比，TR-CA 的培训医生学习曲线似乎较慢，但应鼓励心脏病学住院医师培训计划将 TR 程序作为其课程的一部分。
