Barriers for transradial coronary angiography and interventions in 2016

摘要

Dr. Lucien Campeau reported the first transradial angiography in 1989 followed by Drs. Kiemeneij and Laarman (1992) who performed the first transradial coronary stenting in Amsterdam, The Netherlands. But since then the acceptance rates of transradial catheterization (TRC) have varied considerably and are hugely influenced by the operator and demography of a particular lab — academic training centers have a significantly higher TRC implementation rates compared to community hospitals. In the past few years there has been impressive growth of TRC in the US - from less than 3% (2007) to 16% (2012) to current -36% (2016) of all cardiac catheterizations nationwide in the US according to the Cath-PCI National Cardiovascular Data Registry (NCDR), with wide variation among hospitals (Fig. 1). However, this still compares very poorly against contemporary European practices (67% radial PCI rate in the Swedish SWEDEHEART registry in 2011 and TRC utilization increased from 17.5% to 65.6% in the age group <60, and 16.6% to 54.5% in the age group >80 between 2006 and 2012 in the UK [1 ] per the British Cardiovascular Intervention Society database). Theoretically, this might be related to the lower average operator volume in the US compared to other Western nations which makes it tougher for US interventionalists to develop earlier proficiency in TRC.