Increasing radial PCI use even slightly may lower bleeding rates

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 - Quality_Measures

Hospitals that readily embraced transradial PCI over a three-year period were more likely to see reduced bleeding rates, an analysis of CathPCI data showed. But even facilities that had modest increases in radial PCI use achieved lower access site and overall bleeding rates.

Steven M. Bradley, MD, MPH, of the Veterans Affairs Eastern Colorado Health Care System in Denver, and colleagues tapped the CathPCI registry to assess facility-level trends over time in the use of radial PCI in the U.S. and outcomes. The analysis focused on hospitals with a low baseline rate of radial use, which they set at less than 10 percent in the first year of the study.

They analyzed data from 818 hospitals that performed almost 1.5 million PCI procedures between July 2009 and June 2012. Their primary outcome was access site bleeding. Secondary outcomes included overall periprocedural bleeding, fluoroscopy time and contrast use.

Forty percent of the hospitals had a very low increase in radial use over three years, which was defined as increasing from a baseline of 0.2 percent to a median 1.8 percent by the last quarter of the study period. Another 34.8 percent were ranked as low, with an increase from 0.9 percent to 8.9 percent. The 16.6 percent of hospitals in the moderate bracket increased use from 1.6 percent to 27.2 percent. Only 5 percent of hospitals had a high rate of change, from 1 percent to 45.1 percent.

Risk-adjusted access site bleeding rates decreased across all groups in the three-year span but the hospitals with moderate and high adoption rates had more dramatic declines compared with hospitals in the very low and low categories. Overall bleeding rates also dropped for all categories but the high and moderate group had a steeper decline.

“Although rates of access site bleeding decreased over time across all categories of hospital change in TRI [transradial PCI] use, the risk-adjusted decrease in access site bleeding was 55% ≥3 years at hospitals with moderate to high increases in TRI use when compared with 35% at hospitals with very low to low TRI use,” Bradley et al wrote. “Analysis of overall bleeding rates demonstrated similar findings.”

Fluoroscopy time increased 1.3 minutes in the moderate and high use hospitals and 0.2 minutes in the very low and low use hospitals. Contrast use decreased for all hospital groups over time. They called the increase in fluoroscopy time modest, likely based on imaging requirements for upper extremities. They pointed out that it was unclear how that increase impacted radiation exposure and possible risks to patients.

“Our findings suggest that facilities changing to greater use of TRI are associated with larger reductions in periprocedural bleeding than facilities that have not adopted a radial approach,” they proposed.

The study was published online June 4 in Circulation: Cardiovascular Quality and Outcomes.