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Clinical and Procedural Characteristics Associated With Higher Radiation Exposure During Percutaneous Coronary Interventions and Coronary Angiography

Selected in Circulation Cardiovascular Interventions by M. Dobric

References

Authors

Ronak Delewi, Loes P. Hoebers, Truls Råmunddal, José P.S. Henriques, Oskar Angerås, Jason Stewart, Lotta Robertsson, Magnus Wahlin, Petur Petursson, Jan J. Piek, Per Albertsson, Göran Matejka, Elmir Omerovic

Reference

Circ Cardiovasc Interv. 2013;6:501-506

Published

September 2013

Link

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My Comment

What is known

Radiation exposure of patients during coronary procedures is particularly important as procedures become more complex, since it increases the incidence of both deterministic and stochastic adverse effects. The radial access has gained popularity in recent years, while the data on radiation exposure for transradial procedures remains contradictory.

Major findings

  •  This was a large, multicentre, real-world registry of patients undergoing routine coronary angiography (CAG) or percutaneous coronary intervention (PCI). The total number of procedures included was 20,669 (10 819 CAGs and 9850 PCIs).
  • A few patient and anatomical characteristics were related to increased radiation exposure. Of them, the highest patient radiation exposure was associated with high BMI, history of CABG, increasing number of treated lesions, and PCI of chronic total occlusions.
  • In 59% of the procedures, access route was radial, and 4.0% of all radial procedures were converted to the femoral access site (n=495).
  • Median dose–area product (DAP) value was 48 (interquartile range [IQR], 28–85) Gy·cm2 for procedures (both CAG and PCI) performed via femoral route compared with 44 (26–75) Gy·cm2 for procedures performed via radial route (P<0.001).
  • After multivariable adjustment, radial access route was not associated with increased radiation exposure (β=0.004; SE=0.001; P=0.67).

My Comments

This study addresses the important issue of patient radiation exposure during coronary diagnostic and interventional procedures, which is the factor commonly underappreciated in everyday practice. Among many identified patient and anatomical factors that influence patient radiation exposure, the four most important were identified: high BMI, history of CABG, number of treated lesions, and CTOs. This study demonstrated that approximately 60% of routine procedures were performed using radial approach. The patient dose did not differ between femoral and radial access after adjustment for baseline between-group differences. Nevertheless, the other important issue of operator radiation exposure was not addressed in this study. Finally, all staff and trainee physicians should be well trained in behavioural and technical methods to minimise radiation dose, which, as data suggests, could be similarly accomplished using both femoral and radial approach.

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