Shroff Adhir R, Fernandez Christopher, Vidovich Mladen I, Rao Sunil V, Cowley Michael, Bertrand Olivier F, Patel Tejas M, Pancholy Samir B
University of Illinois - Chicago, Chicago, Illinois.
Duke Clinical Research Institute, Durham, North Carolina.
Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1276-1287. doi: 10.1002/ccd.27989. Epub 2018 Nov 19.
To gain insight into current practice of transradial angiography and intervention in the United States and around the world.
Transradial access (TRA) has grown worldwide. In a prior survey, there was significant practice variation and there was minimal US participation which limited the generalizability to US operators.
We used an internet-based survey software program to solicit input from practicing interventional cardiologists from the United States and around the world. US operators were compared with outside the United States (OUS) operators and respondent-level comparisons were made with the prior survey to assess for temporal changes in practice.
Between August 2016 and January 1, 2017, 125 interventional cardiologists completed the survey representing 91 countries with the United States having 449 (39.9%) respondents. Preprocedure, noninvasive testing for collateral circulation is used more commonly in the United States (54.1%) than around the world (26.6%) but its use has decreased since 2010. In the US, 48.8% of operators never use ultrasound and 92.6% of OUS operators never use it; only 4.4% overall use ultrasound in >50% of cases. Use of bivalirudin has decreased in the US and OUS. Nearly, 30% of operators do not assess for radial artery patency following hemostasis. US respondents used TRA less commonly for primary PCI for STEMI than their global counterparts.
There is wide variation in how TRA procedures are performed including relatively low rates of adherence to practices that are known to improve outcomes. Further education aimed at increasing use of best practices will impact patient outcomes.
深入了解美国及全球经桡动脉血管造影和介入治疗的当前实践情况。
经桡动脉入路（TRA）在全球范围内不断增加。在之前的一项调查中，存在显著的实践差异，且美国的参与度极低，这限制了对美国操作者的普遍适用性。
我们使用基于互联网的调查软件程序，征求来自美国和全球的执业介入心脏病学家的意见。将美国操作者与美国以外（OUS）的操作者进行比较，并将应答者层面的比较结果与之前的调查进行对比，以评估实践中的时间变化。
在2016年8月至2017年1月1日期间，125名介入心脏病学家完成了调查，代表91个国家，其中美国有449名（39.9%）应答者。在术前，美国（54.1%）比全球其他地区（26.6%）更常用无创检测侧支循环，但自2010年以来其使用有所减少。在美国，48.8%的操作者从不使用超声，92.6%的美国以外操作者从不使用；总体上只有4.4%的人在超过50%的病例中使用超声。在美国和美国以外地区，比伐卢定的使用都有所减少。近30%的操作者在止血后不评估桡动脉通畅情况。美国应答者在STEMI的直接经皮冠状动脉介入治疗中使用TRA的频率低于全球同行。
TRA手术的实施方式存在很大差异，包括对已知可改善预后的操作的依从率相对较低。旨在增加最佳实践方法使用的进一步教育将影响患者预后。
