Transfemoral PCI skill: Use it or lose it.….But #RadialFirst.

Despite, earlier concerns, is the article by Badri et al., there was no apparent increase in the rate of vascular complications with transfemoral percutaneous coronary intervention (PCI) associated with increasing levels of adoption of transradial PCI by individuals initially identified as primarily femoral operators (> 90% of PCI's via the femoral artery). Compared with the 2010-2011 period, patients undergoing PCI in the United States in 2014-2015 tended to be generally sicker. This fact, coupled with a liberalization in bleeding definition, likely led to an overall increase in the observed rate of vascular complications post-transfemoral PCI (from 1.3 to 1.64%) across the study time period. Despite the extensive body of evidence supporting the use of transradial over transfemoral PCI access, the vast majority (>80%) of primarily femoral operators in the United States have remained low radial adopters and the overall proportion of PCIs performed transradially across this time period by primarily transfemoral operators increased significantly, yet modestly (from 1.3 to 17.8%).