The Pipeline

ACC 2014: Radial PCI learning curve may be overstated


Jake Kahane, Service Line Strategy Advisor

This year’s ACC conference reviewed the latest in cardiovascular service advancement. Below we highlight one of four key takeaways for our coverage of this year’s scientific session.

Service Line Strategy Advisor has covered the major benefits radial access for endovascular procedures such as PCI can have on your program’s cost of care, length-of-stay (LOS), and readmissions. In the U.S., these clinical and financial benefits have helped radial access utilization for PCI procedures grow from 1.2% of cases in 2007 to 16.1% in the third quarter of 2013. Internationally, transradial utilization rates are even higher—benchmarked at more than 50% of PCI procedures in France, Scandinavian countries, the UK, Spain, and Italy.


A less steep learning curve?

The significant learning curve associated with radial PCI has been the primary reason physicians and administrators are hesitant to adopt the radial approach. Research published based on RIVAL trial data, Vanderbilt registry data, and Wake Forest registry data suggests that the radial learning curve may not be as “steep” as we once believed. The threshold for initial competence appears to be approximately 25 to 40 cases on average, and improvement continues with greater experience whether the operator is a high or low volume operator. 

It should be noted, however, that these findings come from high-volume tertiary care referral centers, so generalizing these findings should be met with caution. Older studies have found, that for some operators, more than 100 cases may be required to develop proficiency.

Transradial access for endovascular procedures lowers costs and improves quality. Hospital leaders and physician champions who transition interventionalists towards radial PCI support efforts to adopt optimal outpatient strategies in the value-based environment. For more information on outpatient strategy, stay tuned to The Pipeline and check out this post on same-day discharge programs for PCI patients.

More from ACC 2014

Want more information on innovations highlighted at ACC? Check out the other posts in our series.

ACC 2014: Promising future for TAVR’s efficacy and LOS
ACC 2014: Renal denervation results call for further investigation
ACC 2014: The future of aortic aneurysm care—PEVAR in the cath lab