Learning Curve in Transradial Coronary Angiography

Transradial (TR) cardiac catheterization is underused, possibly because of perceived technical difficulty and longer procedure times. We compared TR to transfemoral (TF) coronary angiography as performed by experienced TF angiographers with varying TR skills. Data were analyzed for diagnostic angiography without ad hoc intervention over a 12-month period comparing TR to TF procedural and fluoroscopic times, contrast volume, and complication rates. Further analysis was performed according to operators' TR experience (radial expert [REx] vs non-radial expert [nREx]). In total 1,001 patients were identified (661 TR and 340 TF cases) with nRExs performing an average of 63 TR procedures each. All TF procedures were successful and 92% were successful for TR angiography; complication rates were similar regardless of access. Compared to TF procedures fluoroscopic times were longer in the all-operator TR group (5.3 vs 4.0 minutes, p <0.01) but total procedural times were not (TR vs TF 24 vs 22 minutes, p = NS). In the TR group nRExs had longer fluoroscopic and procedural times compared to RExs in the first 3 months of radial experience (8 vs 4.4 minutes, p = 0.02, and 32 vs 22 minutes, p <0.01, respectively); however, the 2 were equivalent in the final 3 months of analysis (5.2 vs 4.5 and 26 vs 19 minutes for nRExs and RExs, respectively, p = NS). Within the nREX group parameters improved in the last compared to the first 6 months (fluoroscopy 6 vs 7.3 minutes, p = 0.04; procedure time 26 vs 30 minutes, p = 0.04). In conclusion, TR coronary procedures appear to be a comparable alternative to TF procedures with a relatively short technical learning curve.