Procedural Volume and Outcomes With Radial or Femoral Access for Coronary Angiography and Intervention
Identifieur interne : 004003 ( Main/Exploration ); précédent : 004002; suivant : 004004Procedural Volume and Outcomes With Radial or Femoral Access for Coronary Angiography and Intervention
Auteurs : Sanjit S. Jolly [Canada] ; John Cairns [Canada] ; Salim Yusuf [Canada] ; Kari Niemela [Finlande] ; Philippe Gabriel [France] ; Matthew Worthley [Australie] ; Emile Ferrari [France] ; Warren J. Cantor [Canada] ; Anthony Fung [Canada] ; Nicholas Valettas [Canada] ; Michael Rokoss [Canada] ; Goran K. Olivecrona [Suède] ; Petr Widimsky [République tchèque] ; Asim N. Cheema [Canada] ; Peggy Gao [Canada] ; Shamir R. Mehta [Canada]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 2014.
Descripteurs français
- Pascal (Inist)
English descriptors
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Abstract
Objectives The study sought to evaluate the relationship between procedural volume and outcomes with radial and femoral approach. Background RIVAL (Radial Vs. femorAL) was a randomized trial of radial versus femoral access for coronary angiography/ intervention (N = 7,021), which overall did not show a difference in primary outcome of death, myocardial infarction, stroke, or non-coronary artery bypass graft major bleeding. Methods In pre-specified subgroup analyses, the hazard ratios for the primary outcome were compared among centers divided by tertiles and among individual operators. A multivariable Cox proportional hazards model was used to determine the independent effect of center and operator volumes after adjusting for other variables. Results In high-volume radial centers, the primary outcome was reduced with radial versus femoral access (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.87) but not in intermediate- (HR: 1.23; 95% CI: 0.88 to 1.72) or low-volume centers (HR: 0.83; 95% CI: 0.52 to 1.31; interaction p = 0.021). High-volume centers enrolled a higher proportion of ST-segment elevation myocardial infarction (STEMI). After adjustment for STEMI, the benefit of radial access persisted at high-volume radial centers. There was no difference in the primary outcome between radial and femoral access by operator volume: high-volume operators (HR: 0.79; 95% CI: 0.48 to 1.28), intermediate (HR: 0.87; 95% CI: 0.60 to 1.27), and low (HR: 1.10; 95% CI: 0.74 to 1.65; interaction p = 0.536). However, in a multivariable model, overall center volume and radial center volume were independently associated with the primary outcome but not femoral center volume (overall percutaneous coronary intervention volume HR: 0.92, 95% CI: 0.88 to 0.96; radial volume HR: 0.88, 95% CI: 0.80 to 0.97; and femoral volume HR: 1.00, 95% CI: 0.94 to 1.07; p = 0.98). Conclusions Procedural volume and expertise are important, particularly for radial percutaneous coronary intervention.
Affiliations:
- Australie, Canada, Finlande, France, République tchèque, Suède
- Bohême centrale, Ontario, Provence-Alpes-Côte d'Azur, Île-de-France
- Nice, Paris, Prague, Toronto
- Université de Toronto
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Procedural Volume and Outcomes With Radial or Femoral Access for Coronary Angiography and Intervention</title><author><name sortKey="Jolly, Sanjit S" sort="Jolly, Sanjit S" uniqKey="Jolly S" first="Sanjit S." last="Jolly">Sanjit S. Jolly</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Cairns, John" sort="Cairns, John" uniqKey="Cairns J" first="John" last="Cairns">John Cairns</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of British Columbia</s1><s2>Vancouver, British Columbia</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of British Columbia</wicri:noRegion></affiliation></author><author><name sortKey="Yusuf, Salim" sort="Yusuf, Salim" uniqKey="Yusuf S" first="Salim" last="Yusuf">Salim Yusuf</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Niemela, Kari" sort="Niemela, Kari" uniqKey="Niemela K" first="Kari" last="Niemela">Kari Niemela</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Tampere University Hospital and Heart Center</s1><s2>Tampere</s2><s3>FIN</s3><sZ>4 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Tampere University Hospital and Heart Center</wicri:noRegion></affiliation></author><author><name sortKey="Gabriel, Philippe" sort="Gabriel, Philippe" uniqKey="Gabriel P" first="Philippe" last="Gabriel">Philippe Gabriel</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Université Paris-Diderot</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Worthley, Matthew" sort="Worthley, Matthew" uniqKey="Worthley M" first="Matthew" last="Worthley">Matthew Worthley</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>University of Adelaide, Royal Adelaide Hospital</s1><s2>Adelaide</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Adelaide</wicri:noRegion></affiliation></author><author><name sortKey="Ferrari, Emile" sort="Ferrari, Emile" uniqKey="Ferrari E" first="Emile" last="Ferrari">Emile Ferrari</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Hopital Pasteur</s1><s2>Nice</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Nice</settlement></placeName></affiliation></author><author><name sortKey="Cantor, Warren J" sort="Cantor, Warren J" uniqKey="Cantor W" first="Warren J." last="Cantor">Warren J. Cantor</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>Southlake Regional Health Centre, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Fung, Anthony" sort="Fung, Anthony" uniqKey="Fung A" first="Anthony" last="Fung">Anthony Fung</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of British Columbia</s1><s2>Vancouver, British Columbia</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of British Columbia</wicri:noRegion></affiliation></author><author><name sortKey="Valettas, Nicholas" sort="Valettas, Nicholas" uniqKey="Valettas N" first="Nicholas" last="Valettas">Nicholas Valettas</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Rokoss, Michael" sort="Rokoss, Michael" uniqKey="Rokoss M" first="Michael" last="Rokoss">Michael Rokoss</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Olivecrona, Goran K" sort="Olivecrona, Goran K" uniqKey="Olivecrona G" first="Goran K." last="Olivecrona">Goran K. Olivecrona</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Skane University Hospital</s1><s2>Lund</s2><s3>SWE</s3><sZ>12 aut.</sZ></inist:fA14><country>Suède</country><wicri:noRegion>Skane University Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Widimsky, Petr" sort="Widimsky, Petr" uniqKey="Widimsky P" first="Petr" last="Widimsky">Petr Widimsky</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Charles University, Hospital Kralovske Vinohrady</s1><s2>Prague</s2><s3>CZE</s3><sZ>13 aut.</sZ></inist:fA14><country>République tchèque</country><placeName><settlement type="city">Prague</settlement><region type="région" nuts="2">Bohême centrale</region></placeName></affiliation></author><author><name sortKey="Cheema, Asim N" sort="Cheema, Asim N" uniqKey="Cheema A" first="Asim N." last="Cheema">Asim N. 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Mehta</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">14-0125794</idno><date when="2014">2014</date><idno type="stanalyst">PASCAL 14-0125794 INIST</idno><idno type="RBID">Pascal:14-0125794</idno><idno type="wicri:Area/PascalFrancis/Corpus">000451</idno><idno type="wicri:Area/PascalFrancis/Curation">005A11</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000139</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000139</idno><idno type="wicri:doubleKey">0735-1097:2014:Jolly S:procedural:volume:and</idno><idno type="wicri:Area/Main/Merge">004063</idno><idno type="wicri:Area/Main/Curation">004003</idno><idno type="wicri:Area/Main/Exploration">004003</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Procedural Volume and Outcomes With Radial or Femoral Access for Coronary Angiography and Intervention</title><author><name sortKey="Jolly, Sanjit S" sort="Jolly, Sanjit S" uniqKey="Jolly S" first="Sanjit S." last="Jolly">Sanjit S. Jolly</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Cairns, John" sort="Cairns, John" uniqKey="Cairns J" first="John" last="Cairns">John Cairns</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of British Columbia</s1><s2>Vancouver, British Columbia</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of British Columbia</wicri:noRegion></affiliation></author><author><name sortKey="Yusuf, Salim" sort="Yusuf, Salim" uniqKey="Yusuf S" first="Salim" last="Yusuf">Salim Yusuf</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Niemela, Kari" sort="Niemela, Kari" uniqKey="Niemela K" first="Kari" last="Niemela">Kari Niemela</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Tampere University Hospital and Heart Center</s1><s2>Tampere</s2><s3>FIN</s3><sZ>4 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Tampere University Hospital and Heart Center</wicri:noRegion></affiliation></author><author><name sortKey="Gabriel, Philippe" sort="Gabriel, Philippe" uniqKey="Gabriel P" first="Philippe" last="Gabriel">Philippe Gabriel</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Université Paris-Diderot</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Worthley, Matthew" sort="Worthley, Matthew" uniqKey="Worthley M" first="Matthew" last="Worthley">Matthew Worthley</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>University of Adelaide, Royal Adelaide Hospital</s1><s2>Adelaide</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Adelaide</wicri:noRegion></affiliation></author><author><name sortKey="Ferrari, Emile" sort="Ferrari, Emile" uniqKey="Ferrari E" first="Emile" last="Ferrari">Emile Ferrari</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Hopital Pasteur</s1><s2>Nice</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Nice</settlement></placeName></affiliation></author><author><name sortKey="Cantor, Warren J" sort="Cantor, Warren J" uniqKey="Cantor W" first="Warren J." last="Cantor">Warren J. Cantor</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>Southlake Regional Health Centre, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Fung, Anthony" sort="Fung, Anthony" uniqKey="Fung A" first="Anthony" last="Fung">Anthony Fung</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of British Columbia</s1><s2>Vancouver, British Columbia</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of British Columbia</wicri:noRegion></affiliation></author><author><name sortKey="Valettas, Nicholas" sort="Valettas, Nicholas" uniqKey="Valettas N" first="Nicholas" last="Valettas">Nicholas Valettas</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Rokoss, Michael" sort="Rokoss, Michael" uniqKey="Rokoss M" first="Michael" last="Rokoss">Michael Rokoss</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Olivecrona, Goran K" sort="Olivecrona, Goran K" uniqKey="Olivecrona G" first="Goran K." last="Olivecrona">Goran K. Olivecrona</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Skane University Hospital</s1><s2>Lund</s2><s3>SWE</s3><sZ>12 aut.</sZ></inist:fA14><country>Suède</country><wicri:noRegion>Skane University Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Widimsky, Petr" sort="Widimsky, Petr" uniqKey="Widimsky P" first="Petr" last="Widimsky">Petr Widimsky</name><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Charles University, Hospital Kralovske Vinohrady</s1><s2>Prague</s2><s3>CZE</s3><sZ>13 aut.</sZ></inist:fA14><country>République tchèque</country><placeName><settlement type="city">Prague</settlement><region type="région" nuts="2">Bohême centrale</region></placeName></affiliation></author><author><name sortKey="Cheema, Asim N" sort="Cheema, Asim N" uniqKey="Cheema A" first="Asim N." last="Cheema">Asim N. Cheema</name><affiliation wicri:level="4"><inist:fA14 i1="10"><s1>St Michael's Hospital, University of Toronto</s1><s2>Ontario</s2><s3>CAN</s3><sZ>14 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Gao, Peggy" sort="Gao, Peggy" uniqKey="Gao P" first="Peggy" last="Gao">Peggy Gao</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Mehta, Shamir R" sort="Mehta, Shamir R" uniqKey="Mehta S" first="Shamir R." last="Mehta">Shamir R. Mehta</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>McMaster University and Population Health Research Institute, Hamilton Health Sciences</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton, Ontario</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Accessibility</term><term>Angioplasty</term><term>Cardiology</term><term>Cardiovascular disease</term><term>Circulatory system</term><term>Coronary arteriography</term><term>Evolution</term><term>Femur</term><term>Instrumentation therapy</term><term>Prognosis</term><term>Volume</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Pathologie de l'appareil circulatoire</term><term>Volume</term><term>Pronostic</term><term>Evolution</term><term>Fémur</term><term>Accessibilité</term><term>Coronarographie</term><term>Angioplastie</term><term>Appareil circulatoire</term><term>Cardiologie</term><term>Traitement instrumental</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives The study sought to evaluate the relationship between procedural volume and outcomes with radial and femoral approach. Background RIVAL (Radial Vs. femorAL) was a randomized trial of radial versus femoral access for coronary angiography/ intervention (N = 7,021), which overall did not show a difference in primary outcome of death, myocardial infarction, stroke, or non-coronary artery bypass graft major bleeding. Methods In pre-specified subgroup analyses, the hazard ratios for the primary outcome were compared among centers divided by tertiles and among individual operators. A multivariable Cox proportional hazards model was used to determine the independent effect of center and operator volumes after adjusting for other variables. Results In high-volume radial centers, the primary outcome was reduced with radial versus femoral access (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.28 to 0.87) but not in intermediate- (HR: 1.23; 95% CI: 0.88 to 1.72) or low-volume centers (HR: 0.83; 95% CI: 0.52 to 1.31; interaction p = 0.021). High-volume centers enrolled a higher proportion of ST-segment elevation myocardial infarction (STEMI). After adjustment for STEMI, the benefit of radial access persisted at high-volume radial centers. There was no difference in the primary outcome between radial and femoral access by operator volume: high-volume operators (HR: 0.79; 95% CI: 0.48 to 1.28), intermediate (HR: 0.87; 95% CI: 0.60 to 1.27), and low (HR: 1.10; 95% CI: 0.74 to 1.65; interaction p = 0.536). However, in a multivariable model, overall center volume and radial center volume were independently associated with the primary outcome but not femoral center volume (overall percutaneous coronary intervention volume HR: 0.92, 95% CI: 0.88 to 0.96; radial volume HR: 0.88, 95% CI: 0.80 to 0.97; and femoral volume HR: 1.00, 95% CI: 0.94 to 1.07; p = 0.98). Conclusions Procedural volume and expertise are important, particularly for radial percutaneous coronary intervention.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Canada</li><li>Finlande</li><li>France</li><li>République tchèque</li><li>Suède</li></country><region><li>Bohême centrale</li><li>Ontario</li><li>Provence-Alpes-Côte d'Azur</li><li>Île-de-France</li></region><settlement><li>Nice</li><li>Paris</li><li>Prague</li><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><noRegion><name sortKey="Jolly, Sanjit S" sort="Jolly, Sanjit S" uniqKey="Jolly S" first="Sanjit S." last="Jolly">Sanjit S. Jolly</name></noRegion><name sortKey="Cairns, John" sort="Cairns, John" uniqKey="Cairns J" first="John" last="Cairns">John Cairns</name><name sortKey="Cantor, Warren J" sort="Cantor, Warren J" uniqKey="Cantor W" first="Warren J." last="Cantor">Warren J. Cantor</name><name sortKey="Cheema, Asim N" sort="Cheema, Asim N" uniqKey="Cheema A" first="Asim N." last="Cheema">Asim N. Cheema</name><name sortKey="Fung, Anthony" sort="Fung, Anthony" uniqKey="Fung A" first="Anthony" last="Fung">Anthony Fung</name><name sortKey="Gao, Peggy" sort="Gao, Peggy" uniqKey="Gao P" first="Peggy" last="Gao">Peggy Gao</name><name sortKey="Mehta, Shamir R" sort="Mehta, Shamir R" uniqKey="Mehta S" first="Shamir R." last="Mehta">Shamir R. Mehta</name><name sortKey="Rokoss, Michael" sort="Rokoss, Michael" uniqKey="Rokoss M" first="Michael" last="Rokoss">Michael Rokoss</name><name sortKey="Valettas, Nicholas" sort="Valettas, Nicholas" uniqKey="Valettas N" first="Nicholas" last="Valettas">Nicholas Valettas</name><name sortKey="Yusuf, Salim" sort="Yusuf, Salim" uniqKey="Yusuf S" first="Salim" last="Yusuf">Salim Yusuf</name></country><country name="Finlande"><noRegion><name sortKey="Niemela, Kari" sort="Niemela, Kari" uniqKey="Niemela K" first="Kari" last="Niemela">Kari Niemela</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Gabriel, Philippe" sort="Gabriel, Philippe" uniqKey="Gabriel P" first="Philippe" last="Gabriel">Philippe Gabriel</name></region><name sortKey="Ferrari, Emile" sort="Ferrari, Emile" uniqKey="Ferrari E" first="Emile" last="Ferrari">Emile Ferrari</name></country><country name="Australie"><noRegion><name sortKey="Worthley, Matthew" sort="Worthley, Matthew" uniqKey="Worthley M" first="Matthew" last="Worthley">Matthew Worthley</name></noRegion></country><country name="Suède"><noRegion><name sortKey="Olivecrona, Goran K" sort="Olivecrona, Goran K" uniqKey="Olivecrona G" first="Goran K." last="Olivecrona">Goran K. Olivecrona</name></noRegion></country><country name="République tchèque"><region name="Bohême centrale"><name sortKey="Widimsky, Petr" sort="Widimsky, Petr" uniqKey="Widimsky P" first="Petr" last="Widimsky">Petr Widimsky</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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