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Changes in Arterial Access Site and Association With Mortality in the United Kingdom: Observations From a National Percutaneous Coronary Intervention Database

Lookup NU author(s): Dr Mark De Belder, Professor Azfar Zaman


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Background The transradial access (TRA) site has become the default access site for percutaneous coronary intervention in the United Kingdom, with randomized trials and national registry data showing reductions in mortality associated with TRA use. This study evaluates regional changes in access site practice in England and Wales over time, examines whether changes in access site practice have been uniform nationally and across different patient subgroups, and provides national estimates for the potential number of lives saved or lost associated with regional differences in access site practice.Methods and Results Using the British Cardiovascular Intervention Society database, we investigated outcomes for growth of TRA in different regions in England and Wales in 448853 patients who underwent percutaneous coronary intervention from 2005 to 2012. Multiple logistic regression was used to quantify the effect of TRA on 30-day mortality and quantify lives saved and lost by differences in TRA adoption. TRA use increased from 14.0% to 58.6% in 417038 PCI patients with large variations in different parts of the country. TRA was independently associated with a decreased risk of 30-day mortality (odds ratio=0.70; 95% confidence interval=0.66-0.74), with significant but small differences observed across different regions. The number of estimated lives saved was 450 (95%confidence interval=275-650), and we estimate that an additional 264 (95% confidence interval=153-399) lives would have been saved if TRA adoption were uniform nationally.Conclusions TRA has become the dominant percutaneous coronary intervention approach in the United Kingdom, with a wide variation in different parts of the country. Changes in practice have contributed to mortality reductions, and inequalities have resulted in missed opportunities for further improvements.

Publication metadata

Author(s): Mamas MA, Nolan J, de Belder MA, Zaman A, Kinnaird T, Curzen N, Kwok CS, Buchan I, Ludman P, Kontopantelis E, British Cardiovasc Intervention So, Natl Inst Clinical Outcomes Res

Publication type: Article

Publication status: Published

Journal: Circulation

Year: 2016

Volume: 133

Issue: 17

Pages: 1655-1667

Print publication date: 26/04/2016

Online publication date: 11/03/2016

Acceptance date: 19/02/2016

ISSN (print): 0009-7322

ISSN (electronic): 1524-4539

Publisher: Lippincott Williams & Wilkins


DOI: 10.1161/CIRCULATIONAHA.115.018083


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Funder referenceFunder name
MR/K006665/1MRC Health eResearch Center