Is there a relationship of operator and center volume with access site related outcomes?: an analysis from the British Cardiovascular Intervention Society

Background: Transradial access (TRA) is associated with reduced access site related bleeding complications and mortality post percutaneous coronary intervention (PCI). The objective of this study is to examine the relationship between access site practice and clinical outcomes and how this may be influenced by operator and center experience/expertise. Methods and Results: The influence of operator and center experience/expertise was studied on 30-day mortality, in-hospital MACE (a composite of in-hospital mortality and in-hospital myocardial infarction and target vessel revascularization) and in-hospital major bleeding based on access site adopted (radial vs femoral). Operator/center experience/expertise were defined by both total volume and TRA proportion. A total of 164,395 procedures between 2012 and 2013 in the NHS in England and Wales were analyzed. After case-mix adjustment, TRA was associated with an average odds reduction of 39% for 30-day mortality compared with transfemoral access (TFA) (OR = 0.61, 95% CI 0.55-0.68, p