Ultrasound-Guided Transfemoral Access for Coronary Procedures: A Pooled Learning Curve Analysis From the FAUST and UNIVERSAL Trials.

التفاصيل البيبلوغرافية
العنوان:	Ultrasound-Guided Transfemoral Access for Coronary Procedures: A Pooled Learning Curve Analysis From the FAUST and UNIVERSAL Trials.
المؤلفون:	d'Entremont MA; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.).; Centre Hospitalier Universitaire de Sherbrooke, QC, Canada (M.-A.d., S.L.-P., E.L.C.)., Seto AH; Long Beach VA Medical Center, CA (A.H.S.)., Alrashidi S; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Alansari O; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Brochu B; CK Hui Heart Center, Edmonton, AB, Canada (B.B.)., Lemaire-Paquette S; Centre Hospitalier Universitaire de Sherbrooke, QC, Canada (M.-A.d., S.L.-P., E.L.C.)., Heenan L; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.)., Skuriat E; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.)., Tyrwhitt J; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.)., Raco M; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Tsang MB; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Valettas N; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Velianou J; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Sheth T; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Sibbald M; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Mehta SR; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Pinilla-Echeverri N; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Schwalm JD; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Natarajan MK; Population Health Research Institute, Hamilton, ON, Canada (M.-A.d., L.H., E.S., J.T., T.S., S.R.M., J.-D.S., M.K.N., S.S.J.).; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; Department of Medicine, McMaster University, Hamilton, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., J.B., J.N., S.S.J.)., Abu-Fadel M; Oklahoma Heart Hospital (M.A.-F.)., Kelly A; Hamilton Health Sciences, ON, Canada (M.-A.d., S.A., O.A., M.R., M.B.T., N.V., J.V., T.S., M.S., S.R.M., N.P.-E., J.-D.S., M.K.N., A.K., S.T., W.F., J.B., R.M., J.N., G.D., S.S.J.).; 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المصدر:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2024 Aug; Vol. 17 (8), pp. e013817. Date of Electronic Publication: 2024 Jun 18.
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101499602 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-7632 (Electronic) Linking ISSN: 19417640 NLM ISO Abbreviation: Circ Cardiovasc Interv Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Hagerstown, MD : Lippincott Williams & Wilkins
مواضيع طبية MeSH:	Femoral Artery/diagnostic imaging , Learning Curve , Ultrasonography, Interventional/adverse effects , Clinical Competence , Catheterization, Peripheral/adverse effects , Punctures , Randomized Controlled Trials as Topic* , Percutaneous Coronary Intervention/education , Percutaneous Coronary Intervention/adverse effects, Humans ; Male ; Female ; Middle Aged ; Aged ; Risk Factors ; Treatment Outcome ; Hemorrhage/prevention & control ; Hemorrhage/etiology ; Cardiac Catheterization/adverse effects ; Multicenter Studies as Topic
مستخلص:	Background: The learning curve for new operators performing ultrasound-guided transfemoral access (TFA) remains uncertain. Methods: We performed a pooled analysis of the FAUST (Femoral Arterial Access With Ultrasound Trial) and UNIVERSAL (Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures) trials, both multicenter randomized controlled trials of 1:1 ultrasound-guided versus non-ultrasound-guided TFA for coronary procedures. Outcomes included the composite of major bleeding or vascular complications and successful common femoral artery cannulation. Participants were stratified by the operators' accrued case volume. We used adjusted repeated-measurement logistic regression, with random intercepts for operator clustering, for comparison against the non-ultrasound-guided TFA group and to model the learning curve. Results: The FAUST and UNIVERSAL trials randomized a total of 1624 patients, of which 810 were randomized to non-ultrasound-guided TFA and 814 to ultrasound-guided TFA (cases 1-10, 391; 11-20, 183; and >20, 240). Participants who had operators who performed >20 ultrasound-guided TFAs had a decreased risk for the primary end point (5/240 [2.1%] versus 64/810 [7.9%]; adjusted odds ratio, 0.26 [95% CI, 0.09-0.61]) compared with non-ultrasound-guided TFA. Operators who performed >20 ultrasound-guided procedures had increased odds of successfully cannulating the common femoral artery (224/246 [91.1%] versus 327/382 [85.6%]; adjusted odds ratio, 1.76 [95% CI, 1.08-2.89]) compared with non-ultrasound-guided TFA. The learning curve plots demonstrated growing competence with increasing accrued cases. Conclusions: New operators should perform at least 20 ultrasound-guided TFA to decrease access site complications and increase proper cannulation compared with non-ultrasound-guided TFA. Additional accrued cases may lead to increased proficiency. Training programs should consider these findings in the transradial era. Competing Interests: Dr d’Entremont is a Canadian Institutes of Health Research Canada Graduate Scholarship awardee. Dr Jolly reports receiving grants or contracts from Boston Scientific and payment or honoraria for lectures, presentations, speaker’s bureaus, article writing, or educational events from Penumbra, Teleflex, and Abiomed. Dr Seto reports receiving grants or contracts from Arena Medical, Philips, and ACIST; payment or honoraria for speaker’s bureaus from Janssen, Terumo, Gettinge, and GE Healthcare; consulting fees from Medtronic and Medicure; and reports having equity in Frond Medical. The other authors report no conflicts.
فهرسة مساهمة:	Keywords: cardiology; femoral artery; hemorrhage; percutaneous coronary intervention; pulse; ultrasonography
تواريخ الأحداث:	Date Created: 20240618 Date Completed: 20240820 Latest Revision: 20240820
رمز التحديث:	20240821
DOI:	10.1161/CIRCINTERVENTIONS.123.013817
PMID:	38887948
قاعدة البيانات:	MEDLINE

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تدمد:	1941-7632
DOI:	10.1161/CIRCINTERVENTIONS.123.013817