Transradial Access and Radiation Exposure in Coronary Procedures
Transradial Access and Radiation Exposure in Coronary Procedures
Background. Although transradial access (TRA) is being increasingly used in interventional cardiology, there are concerns about a possible increase in radiation exposure (RE) as compared to transfemoral access (TFA).
Methods. In this retrospective study, we aimed to compare RE during coronary angiography and percutaneous coronary intervention (PCI) according to the vascular access route (TRA vs TFA). We included all procedures performed in our laboratory, in which RE data (dose area product, cGy•cm) were available, from May 2009 to May 2013. Both multiple linear regression analysis and propensity score matching were performed in order to compare RE between TRA and TFA after adjusting for clinical and procedural confounders.
Results. DAP values were available for 1396 procedures; TRA rate was 82.6%. TRA patients were younger, less frequently female, and had higher body mass index as compared to TFA patients; the rates of PCI, ad hoc PCI, bypass angiography, thrombus aspiration, and primary angioplasty, as well as the number of stents implanted, fluoroscopy time, and contrast dose were significantly higher in TFA. Median DAP value was significantly higher in TFA than in TRA (9670 cGy•cm vs 7635 cGy•cm; P<.01). After adjusting for clinical and procedural confounders, vascular access was not found to be an independent predictor of RE at multiple regression analysis; this was also confirmed by stratified comparison of DAP values by quintiles of propensity score.
Conclusion. After adjusting for clinical and procedural confounders, TRA was not found to be associated with increased RE as compared to TFA in an experienced TRA center.
Transradial access (TRA) is being increasingly used worldwide for coronary angiography (CA) and percutaneous coronary intervention (PCI), since it offers several advantages as compared to transfemoral approach (TFA), such as significant reduction in vascular complications, increased patient comfort, reduced hospital stay, and lower cost. Moreover, in the setting of ST-elevation myocardial infarction (STEMI), TRA is associated with reduced short-term mortality as compared to TFA, mainly mediated by a reduction in bleeding complications. Nevertheless, TRA is technically more demanding than TFA and requires appropriate training and the completion of a learning curve to be mastered by the operator and to prove safe and effective. Technical difficulties, especially at the beginning of the learning curve, are mainly represented by catheter manipulation and negotiation of coronary ostia; these maneuvers are usually not as straightforward as in TFA and may require more time and more fluoroscopic guidance, possibly leading to increased radiation exposure for both patients and operators.
Medical exposure to x-ray in the field of interventional cardiology represents an important issue, since x-rays are associated with both deterministic effects, such as radiation-induced injuries in patients' skin, and to stochastic effects, such as radiation-induced cancer.
Whether TRA is associated with increased radiation exposure is still a matter of debate, since conflicting data have been reported. Indeed, many studies were observational, excluded some procedure types (such as bypass angiography, and primary PCI), and included procedures performed by physicians in training or with initial experience in TRA.
The aim of the present study is to investigate radiation exposure during CA and PCI in a moderate-volume center with high rate of TRA.
Abstract and Introduction
Abstract
Background. Although transradial access (TRA) is being increasingly used in interventional cardiology, there are concerns about a possible increase in radiation exposure (RE) as compared to transfemoral access (TFA).
Methods. In this retrospective study, we aimed to compare RE during coronary angiography and percutaneous coronary intervention (PCI) according to the vascular access route (TRA vs TFA). We included all procedures performed in our laboratory, in which RE data (dose area product, cGy•cm) were available, from May 2009 to May 2013. Both multiple linear regression analysis and propensity score matching were performed in order to compare RE between TRA and TFA after adjusting for clinical and procedural confounders.
Results. DAP values were available for 1396 procedures; TRA rate was 82.6%. TRA patients were younger, less frequently female, and had higher body mass index as compared to TFA patients; the rates of PCI, ad hoc PCI, bypass angiography, thrombus aspiration, and primary angioplasty, as well as the number of stents implanted, fluoroscopy time, and contrast dose were significantly higher in TFA. Median DAP value was significantly higher in TFA than in TRA (9670 cGy•cm vs 7635 cGy•cm; P<.01). After adjusting for clinical and procedural confounders, vascular access was not found to be an independent predictor of RE at multiple regression analysis; this was also confirmed by stratified comparison of DAP values by quintiles of propensity score.
Conclusion. After adjusting for clinical and procedural confounders, TRA was not found to be associated with increased RE as compared to TFA in an experienced TRA center.
Introduction
Transradial access (TRA) is being increasingly used worldwide for coronary angiography (CA) and percutaneous coronary intervention (PCI), since it offers several advantages as compared to transfemoral approach (TFA), such as significant reduction in vascular complications, increased patient comfort, reduced hospital stay, and lower cost. Moreover, in the setting of ST-elevation myocardial infarction (STEMI), TRA is associated with reduced short-term mortality as compared to TFA, mainly mediated by a reduction in bleeding complications. Nevertheless, TRA is technically more demanding than TFA and requires appropriate training and the completion of a learning curve to be mastered by the operator and to prove safe and effective. Technical difficulties, especially at the beginning of the learning curve, are mainly represented by catheter manipulation and negotiation of coronary ostia; these maneuvers are usually not as straightforward as in TFA and may require more time and more fluoroscopic guidance, possibly leading to increased radiation exposure for both patients and operators.
Medical exposure to x-ray in the field of interventional cardiology represents an important issue, since x-rays are associated with both deterministic effects, such as radiation-induced injuries in patients' skin, and to stochastic effects, such as radiation-induced cancer.
Whether TRA is associated with increased radiation exposure is still a matter of debate, since conflicting data have been reported. Indeed, many studies were observational, excluded some procedure types (such as bypass angiography, and primary PCI), and included procedures performed by physicians in training or with initial experience in TRA.
The aim of the present study is to investigate radiation exposure during CA and PCI in a moderate-volume center with high rate of TRA.
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