Coronary arteriography performed by a physician assistant

Area of Science:

• Cardiovascular Medicine
• Medical Education
• Interventional Cardiology

Background:

• Cardiology fellowship training faces challenges due to funding constraints and an oversupply of cardiologists.
• Catheterization laboratory workload can be a limiting factor in training, impacting the number of cardiology fellows.
• Investigating alternative healthcare professionals for procedural tasks is crucial for optimizing training programs.

Purpose of the Study:

• To evaluate the feasibility and safety of physician assistants (PAs) performing coronary arteriography.
• To determine if PAs can perform coronary arteriography independently of cardiology fellowship training needs.
• To assess if PAs can help uncouple fellowship training from catheterization laboratory workload.

Main Methods:

• A prospective study involving 150 patients undergoing coronary arteriography performed by a PA.
• Comparison of complication rates, procedure times, and fluoroscopy times between PAs and cardiology fellows.
• Statistical analysis to determine significant differences in procedural outcomes and efficiency.

Main Results:

• No major adverse events (death, myocardial infarction, stroke) occurred in the 150 PA-performed procedures.
• The complication rate for PAs (1.3%) was comparable to that of cardiology fellows (1.3%).
• Procedure and fluoroscopy times were similar, with only preoperative fluoroscopy time showing a statistically significant difference (p = 0.02).

Conclusions:

• Physician assistants can be safely substituted for cardiology fellows in performing coronary arteriography.
• This substitution offers a viable solution for institutions where procedure volume exceeds fellowship training capacity.
• Implementing PAs in this role can help manage workforce challenges and optimize resource utilization in cardiology.