e., procedure success) (4.6%).

And although 55% reported that they had received TRI training during fellowship, only 11% had primarily trained using radial access during fellowship (data not reported in table). The most prevalent ZD1839 supplier barriers (Table 3) interventional cardiologists cited were concerns about increased radiation exposure to the interventional cardiologist (60.0% of respondents cited as major or minor barrier) and to other cath team members (47.7% of respondents), and learning curve (43.1%). However even among these, most respondents rated them as minor rather than major barriers. Other barriers such as difficulty obtaining necessary equipment (24.6%), lack of support from cath lab staff (20.0%), and lack of training opportunities (18.5%), were cited less frequently by our survey respondents. Overall, few respondents rated any factor as a major barrier to performing TRI. Responses to the free text field, reinforced interview findings that suggested that interventional cardiologists find radial cases to be more challenging; feel less capable of dealing with

problems via radial access; and harbor doubts about the evidence supporting radial efficacy for specific subgroups of patients. Among the 48 cath labs represented in the survey data, the median PCI volume in 2013 was 199, with 7.4% of those trans-radial (Table 4). Cath labs in the see more top tertile for TRI rate conducted 51.7% of PCIs trans-radially, versus 7.8% and 2.7% for the middle and bottom tertile cath labs. Stratified responses were similar to the total respondents, with respondents favoring radial

access (Table 2) for ease of monitoring patients, allowing patients to go home sooner, fewer vascular access complications, comfort for patients, and fewer bleeding complications, with moderately less favorable views among the middle and bottom tertiles. The most prevalent barriers for the high-tertile respondents (Table 3) were the long learning curve (55.0%), increased radiation exposure to the operator (45.0%) and to the cath team (40.0%), whereas the most prevalent barriers for middle and low-tertile respondents included logistical issues other than lack of standard policies or difficulties Casein kinase 1 obtaining necessary equipment (53.8%), and minorities of low-tertile (46.2%) and middle-tertile (26.3%) respondents rated the long learning curve as a barrier. Open text responses exhibited a similar pattern with respondents at low-TRI sites reporting procedure time and technical difficulty as the major issues (Table 5). Lack of support in changing post-procedure policies, specifically related to removal of hemostasis band, was also cited. The US lags behind many other industrialized nations in the use of TRI [1], and to the best of our knowledge there has been little empirical study to understand why.