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Characterization of operator learning curve for transradial coronary interventions.
Warren T Ball1, Waseem Sharieff, Sanjit S Jolly
1Terrence Donnelly Heart Center, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
Circulation. Cardiovascular Interventions
|August 5, 2011
Summary
Transradial percutaneous coronary intervention (TR-PCI) requires operator experience for optimal outcomes. Achieving at least 50 cases improves success rates and reduces complications, comparable to experienced operators.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access Techniques
Background:
- Transradial percutaneous coronary intervention (TR-PCI) offers improved clinical outcomes over the transfemoral approach.
- Widespread adoption of TR-PCI is hindered by limited interventional cardiologist training and experience.
Purpose of the Study:
- To determine the minimum case volume of transradial percutaneous coronary intervention (TR-PCI) necessary for interventional cardiologists to achieve optimal clinical benefit.
- To identify the learning curve associated with the TR-PCI procedure.
Main Methods:
- Prospective collection of clinical and procedural data for 1672 TR-PCI cases performed by 28 operators from 1999 to 2008.
- Stratification of operators into case volume groups (1-50, 51-100, 101-150, 151-300, and >300 cases) to compare TR-PCI failure rates, contrast use, and fluoroscopy time.
Main Results:
- TR-PCI failure rates were significantly higher in the initial 1-50 case volume group compared to the 51-100 and >300 case groups (P=0.007, P=0.01).
- Increased contrast use and fluoroscopy time were observed in the 1-50 case volume group compared to higher volume groups.
- Operator case volume was inversely correlated with TR-PCI failure (β=-0.0076, P=0.0028), with a 32% reduction in failure odds for every 50 additional cases.
Conclusions:
- Operator experience is critical for successful transradial percutaneous coronary intervention (TR-PCI).
- A minimum of 50 TR-PCI cases is recommended for operators to achieve clinical outcomes comparable to experienced physicians.
- These findings support the need for defined training standards and skill development for interventional cardiologists adopting the TR-PCI approach.
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