Patient Versus Physician Variation in Use of Transradial Percutaneous Coronary Intervention

Abstract The prevalence of radial access for transradial catheterization remains low in the US, occurring in only 28% of cases in the National Cardiovascular Data Registry (NCDR ® ) CathPCI ® . It is unknown whether the low adoption rate has been influenced by patient characteristics, or is more operator dependent. In a 10-center study, we compared clinical and demographic characteristics among 323 radial and 1506 femoral access PCIs performed by 65 interventionists capable of radial percutaneous intervention (PCI). We created a hierarchical logistic regression model to identify operator and patient characteristics associated with radial PCI and the median rate ratio to quantify the variation across operators. A subset was interviewed to assess health literacy and preferences in shared medical decision-making. Radial access was used in 17.7% of patients. Patient factors associated with lower rate of radial PCI were prior PCI (33.4% vs 41.4% P=0.008), history of Coronary Artery Bypass Graft (8.4% vs 23.0% P