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The transradial (TR) approach is increasingly being used as the default access for coronary angiography. A decrement in fluoroscopy time (FT) is one objective measure of competency. There is, however, limited data on the FT of cardiology trainees performing TR angiography. This study aims to establish if a difference in TR FT exists between consultants and trainees, investigate if trainees have shorter TR FT with increasing seniority, and determine a minimum number of TR cases to overcome the potential “learning curve”.
FT in outpatients at the University Hospital Geelong, Australia was assessed over four years. Cases were dichotomized to with trainee (trainee) or without trainee (consultant) present in the catherization laboratory. Complex cases were excluded.
1699 patients underwent diagnostic coronary angiography during the study period, where the trainee was present in 707 or 55.5% of cases. 47.4% of trainee cases were done radially. Patients in the trainee cohort were older, but there was no other significant difference in baseline characteristics. Trainee cases had longer FT (6.7 vs 4.5 mins, p<0.001) when compared to consultant cases, but the median TR FT of trainees improved between their first and second fifty cases (7.1 vs 6.1 mins, p-value 0.0015). After the first fifty radial cases, the median trainee FT fell within the IQR of consultant TR times (2.9 – 7.0min).
|Consultant (n = 567)||Trainee (n=707)||p-value|
|Age, years [median]||65.0 [57.5 – 72.3]||70.0 [61.0 – 77.3]||0.01|
|Height, cm||168.0 [160.8 – 175.0]||171.0 [164.0 – 178.0]||NS|
|Weight, kg||79.5 [69.8 – 95.5]||83.0 [73.0 – 94.3]||NS|
|Body Mass Index [median]||27.9 [24.5 – 33.4]||28.2 [25.6 – 31.7]||NS|
Cardiology trainees have longer TR FT compared to consultant cardiologists. However, these times improved over time, with a significant improvement seen after a minimum of fifty cases.
OTHER: Quality, Guidelines and Appropriateness Criteria