{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:12:24Z","timestamp":1792145544893,"version":"4.4.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Prior studies of radial access for cardiac catheterization have focused on early adopters of the technique, and some have described a risk\/treatment paradox of low radial access use among high bleeding risk patients. This study aimed to determine (1) trends in radial access use over time, (2) if increasing use of radial access is driven by new invasive and interventional cardiologists (operators) or existing operators changing their practice, and (3) if increasing radial rates are associated with lower bleeding rates and elimination of the risk\/treatment paradox.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>In this cross-sectional study using data from the Clinical Assessment, Reporting, and Tracking Program, we calculated radial access rates and risk-adjusted postprocedural bleeding rates of patients undergoing diagnostic angiography or percutaneous coronary intervention (PCI) between 2011 and 2018 in Veterans Affairs hospitals. We used separate bleeding risk models for diagnostic angiography and PCI and assessed temporal trends with the Kendall Tau-b test.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Among 253\u2009179 diagnostic angiograms and 93\u2009614 PCIs, radial access rates increased over time for both diagnostic (17.5%\u201360.4%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01)) and PCI procedures (14.0%\u201351.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). Existing operators and new operators increased their use at similar rates, but new operators entered practice with higher baseline rates. Nearly all operators used radial access at least once in 2018. Overall adjusted rates of bleeding declined, a trend that was significant for diagnostic angiography (2.4%\u20131.4%,\n              <jats:italic>P<\/jats:italic>\n              =0.02) but not PCI (3.4%\u20132.5%,\n              <jats:italic>P<\/jats:italic>\n              =0.20). Femoral access patients had a higher predicted risk for bleeding.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>A steady rise in radial access for diagnostic angiography and PCI was driven by increasing use among existing operators and high use by new operators. While this was associated with decreasing bleeding rates, a risk\/treatment paradox for access site selection persists; patients at higher bleeding risk were still more likely to receive femoral access.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.121.008359","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T10:00:18Z","timestamp":1646992818000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Trends in Arterial Access Site Selection and Bleeding Outcomes Following Coronary Procedures, 2011\u20132018"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1459-0262","authenticated-orcid":true,"given":"Jacob A.","family":"Doll","sequence":"first","affiliation":[{"name":"Health Services Research &amp; Development (HSR&amp;D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.)."},{"name":"Division of Cardiology, Department of Medicine (J.A.D.), University of Washington, Seattle."},{"name":"CART Program, VHA Office of Quality and Patient Safety, Washington DC (J.A.D., S.W.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5206-5680","authenticated-orcid":true,"given":"Kristine","family":"Beaver","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; Development (HSR&amp;D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Naranjo","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, University of Utah (D.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Waldo","sequence":"additional","affiliation":[{"name":"CART Program, VHA Office of Quality and Patient Safety, Washington DC (J.A.D., S.W.W.)."},{"name":"VA Eastern Colorado Health Care System, Aurora, CO (S.W.W.)."},{"name":"Division of Cardiology, Department of Medicine, University of Colorado, Aurora (S.W.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Maynard","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; Development (HSR&amp;D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian D.","family":"Helfrich","sequence":"additional","affiliation":[{"name":"Health Services Research &amp; Development (HSR&amp;D), Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System, WA (J.A.D., K.B., C.M., C.D.H.)."},{"name":"Department of Health Services, School of Public Health (C.D.H.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2914-0894","authenticated-orcid":true,"given":"Sunil V.","family":"Rao","sequence":"additional","affiliation":[{"name":"US Department of Veterans Affairs (VA) Health Care System, Durham, NC (S.V.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.01.039"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012318.pub2"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.27039"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.04.014"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810160103"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.08.1651"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60404-2"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.06.017"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60292-6"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.04.014"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.113.000110"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000536"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.006356"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.02.035"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008551"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.708"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.12.009"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31823a5596"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.018083"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.11.004"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.15.1458"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.27673"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-020-01802-z"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2014.08.006"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000174"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2021.01.019"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2020.07.033"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.04.016"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29330"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.120.009994"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.121.008359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T03:22:54Z","timestamp":1715570574000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.121.008359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.121.008359"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.121.008359","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"value":"1941-7713","type":"print"},{"value":"1941-7705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]},"assertion":[{"value":"2021-06-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}