TCT: Procedure time is best gauge of angio competence

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SAN FRANCISCO—Procedure time is the most useful indicator of experience in angiography from the femoral route, although radial procedure times do not improve significantly with training, according to a U.K. study presented this week at the 2009 Transcatheter Cardiovascular Therapeutics scientific symposium.

Lead author J.R. Wilkinson, MBBS, from the department of cardiology at London Chest Hospital Barts and the London Trust Hospital in London, said that the benefits of radial versus femoral access include reduction in vascular complications and patient preference. However, he acknowledged that radial cases take longer and have higher fluoroscopy times and radiation doses.

In the study, the researchers set out to identify if any of these correlated with the years of training in angiography. They used an institutional electronic database of all cath lab procedures to identify all diagnostic angiograms conducted over a one-year period.

Out of 2,909 cases, 1,961 were femoral, 500 were radial and 448 were unspecified. The complication rate was slightly higher among the femoral cases (0.007 vs. 0 percent). The complications in the femoral cases included: one aortic dissection, six arterial dissections, three pseudoaneurysms, two major hemorrhages and two minor hemorrhages.

Wilkinson reported that the average procedure time decreased significantly with each year of training, starting at an average of 40 minutes with three years of training, which was reduced to about 25 minutes after six years of training.

However, procedure time was significantly longer in radial cases for all years of training.

Although fluoroscopy time is often used as a surrogate marker of competence in angiography, Wilkinson noted that there was no significant reduction in this over the years of training.

“Only year-four trainees had a significant difference in fluoroscopy time between radial and femoral cases,” he said.

Also, the researchers observed a trend of higher radiation doses in the radial versus femoral group for each year of training. However, this finding was “only statistically significant for year-four trainees,” Wilkinson said.

Based on their observations, the researchers concluded that procedure time is a useful indicator of angiographic experience.

They also found that “fluoroscopy and radiation dose are not reliable discriminators of years of training;” and they are least helpful in the radial cases.

Also, Wilkinson noted a trend toward reduction in both parameters over the years of training for femoral cases.