1. Transradial Intervention Around the Globe: Trends and Forecasts
Sunil V. Rao MD
Duke University Medical Center
Duke Clinical Research Institute
Durham VA Medical Center

2. Disclosures Consultant/Honoraria Research funding
The Medicines Company, Medtronic, Astra Zeneca, ZOLL
Research funding
Ikaria
Off-label uses of drugs/devices may be discussed

3. Transradial Trends and Forecasts
Where have we been?
Where are we going?
What is driving the trends?
Summary

4. Transradial Trends and Forecasts
Where have we been?
Where are we going?
What is driving the trends?
Summary

5. Worldwide Transradial PCI Utilization 2004-2007
National Database
Estimates
KEY POINTS
This slide depicts worldwide transradial PCI utilization based on either data from National Database Registries or 2009 estimates.1
It can be noted that, in comparison to other countries, the United States lags in the utilization of transradial PCI.
Percentages represent data in figure:
National Database Estimates1
REFERENCE
Caputo RP, Tremmel JA, Rao S, et al. Transradial arterial access for coronary and peripheral procedures: executive summary by the Transradial Committee of the SCAI. Catheter Cardiovasc Interv. 2011;78:
Data based on National Database Registries (2008 or 2008/9) or estimates (2009).
Country
% Radial
France 55 UK 35
Poland
21.8 US
1.7
Country
% Radial
Germany 25
Spain 43
Italy
Canada 50
Japan 60
India 32
China
Caputo RP et al. Catheter Cardiovasc Interv. 2011;78:

6. Prevalence of radial approach in the US 2004-2007
N = 593,094 PCI procedures
606 sites
1.3% of all PCI procedures
Rao SV, et. al. JACC: CI 2008

7. Radial volume at US Sites 2004-2007
Rao SV, et. al. JACC Intv 2008

8. Transradial Trends and Forecasts
Where have we been?
Where are we going?
What is driving the trends?
Summary

9. US Radial uptake 2007-2012; N=2.8 million procedures from 1381 sites
Feldman D, et. al. Circ 2013

10. US Radial uptake 2007-2012; N=2.8 million procedures from 1381 sites
Feldman D, et. al. Circ 2013

11. US Radial uptake 2007-2012; N=2.8 million procedures from 1381 sites
Feldman D, et. al. Circ 2013

12. Radial approach in the United Kingdom
Total
Radial
Femoral
Transradial course

13. Transradial Trends and Forecasts
Where have we been?
Where are we going?
What is driving the trends?
Summary

14. Radial approach: Drivers of uptake
Clinical evidence
Guidelines
Training courses
Marketing
Population trends

15. Radial mega-analysis N=76 studies (15 rand; 61 obs); 761,919 patients
Bertrand OF, et. al. AHJ 2012

16. ACC/AHA/SCAI Recommendation COR LOE
PCI Guidelines
ACC/AHA/SCAI
Recommendation
COR
LOE
Radial artery access to decrease access site complications
IIa A
Hillis LD, et. al. JACC 2011

17. MARS 2012 AIM-RADIAL 2012 19th Annual Transradial Master Class
Crewe, UK

20. These are my people…

23. Changing definition of “Outpatient”
CMS Moves Benchmark to Stays Spanning At Least Two Midnights for Inpatient Admission – Began October 1, 2013
Patient stays spanning at least two midnights will be presumed to qualify for Inpatient admission
Patient stays spanning fewer than two midnights will be presumed to qualify only for Outpatient payment.
Admitting physician is required to document their expectation of the supposed need for at least a 48-hour stay (crossing the two midnights) and the evidence used to make said decision, to clearly and completely support their order for admission.
CMS has now modified the criteria for Inpatient admission. These changes are effective starting Oct 1, However, CMS has recently announced that it will not allow RACs to enforce the new 2-midnight rule until Jan 1, 2014 in order to give hospitals some time to adjust to the new admission criteria.
Source: FY 2014 IPPS Final Rule

24. Same-day discharge in the US N=107,018 elective PCI procedures from 903 sites Prevalence of same-day discharge 1.25%
30-day death or rehosp
Rao SV, et. al. JAMA 2011

25. You can’t wake a person who is pretending to be asleep
- Navajo proverb

26. Transradial trends and forecasts
There has been a significant increase in the use of radial artery access in the USA and the UK
Likely mirrored in other countries
Change driven by evidence, guidelines, availability of training, market forces, and population trends
The growth of radial will likely continue to increase
Obsolescence of interventional cardiologists who refuse to adapt and adopt
Policy changes that emphasize value over volume

27. Duke Univ. Medical Center Duke Clinical Research Institute
“The practice of medicine should be based on science;
“The ‘art’ of medicine is in how you interact with the patient.
- Robert M. Califf MD
Duke Clinical Research Institute