Jean-Louis Georges1, Loic Belle2, Ludovic Meunier3, Thierry Dechery4, Khalifé Khalifé5, Max Pecheux6, Simon Elhaddad7, Nicolas Amabile8, Michel Pansieri9, Jacques Ballout10, Xavier Marchand11, Gilles Rouault12, Pierre Leddet13, Olivier Nugue14, Nicolas Lucke15, Simon Cattan16. 1. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier de Versailles, 78150 Le Chesnay, France. Electronic address: jgeorges@ch-versailles.fr. 2. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier de la Région d'Annecy, 74370 Metz-Tessy, France. 3. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Groupe Hospitalier La Rochelle-Ré-Aunis, 17000 La Rochelle, France. 4. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Jacques-Cœur, 18000 Bourges, France. 5. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Régional Notre-Dame de Bon Secours, 57085 Metz, France. 6. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier du Docteur-Schaffner, 62300 Lens, France. 7. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier de Lagny-Marne-la-Vallée, 77600 Jossigny, France. 8. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Medico Chirurgical Marie-Lannelongue, 92350 Le Plessis-Robinson, France. 9. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Henri-Duffaut, 84000 Avignon, France. 10. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Hôpital Pierre-Bérégovoy, 58000 Nevers, France. 11. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier intercommunal de Poissy-Saint-Germain, 78300 Poissy, France. 12. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Intercommunal de Cornouaille, 29107 Quimper, France. 13. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier d'Haguenau, 67500 Haguenau, France. 14. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier du Docteur-Duchêne, 62200 Boulogne-sur-Mer, France. 15. Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Général Girac-Angoulême, 16959 Angoulême, France. 16. Service de Cardiologie, Centre Hospitalier Intercommunal de Le Raincy-Montfermeil, 93370 Montfermeil, France.
Abstract
BACKGROUND: Literature suggests that radial access is associated with higher radiation doses than femoral access. AIMS: To compare patient radiation exposure during coronary angiography (CA) and percutaneous coronary intervention (PCI) with radial versus femoral access. METHODS: RAY'ACT is a nationwide, multicentre, French survey evaluating patient radiation in interventional cardiology. Variables of patient exposure from 21,675 CAs and 17,109 PCIs performed at 44 centres during 2010 were analysed retrospectively. RESULTS: Radial access was used in 71% of CAs and 69% of PCIs. Although median fluoroscopy times were longer for radial versus femoral access (CA, 3.8 vs 3.5minutes [P<0.001]; PCI, 10.4 vs 10.1minutes [P=0.001]), the Kerma-area product (KAP) was lower with radial access (CA, 26.8 vs 28.1Gy·cm2; PCI, 55.6 vs 59.4Gy·cm2; both P=0.001). Differences in KAP remained significant in the multivariable analysis (P<0.01), and in a propensity score-matched analysis (P=0.01). A significant interaction was found between KAP and the percentage of procedures with radial access by centre (P<0.001). KAP was higher by radial versus femoral access in low-radial-volume centres, and lower in high-radial-volume centres. Radiation protection techniques, such as the use of low frame rates (7.5 frame/s), were used more frequently in high-radial-volume radial centres. CONCLUSIONS: In this multicentre study, radial access was associated with lower radiation doses to patient than femoral access in high-radial-volume centres. Provided that radioprotection methods are implemented, radial access could be associated with lower patient radiation exposure.
BACKGROUND: Literature suggests that radial access is associated with higher radiation doses than femoral access. AIMS: To compare patient radiation exposure during coronary angiography (CA) and percutaneous coronary intervention (PCI) with radial versus femoral access. METHODS: RAY'ACT is a nationwide, multicentre, French survey evaluating patient radiation in interventional cardiology. Variables of patient exposure from 21,675 CAs and 17,109 PCIs performed at 44 centres during 2010 were analysed retrospectively. RESULTS: Radial access was used in 71% of CAs and 69% of PCIs. Although median fluoroscopy times were longer for radial versus femoral access (CA, 3.8 vs 3.5minutes [P<0.001]; PCI, 10.4 vs 10.1minutes [P=0.001]), the Kerma-area product (KAP) was lower with radial access (CA, 26.8 vs 28.1Gy·cm2; PCI, 55.6 vs 59.4Gy·cm2; both P=0.001). Differences in KAP remained significant in the multivariable analysis (P<0.01), and in a propensity score-matched analysis (P=0.01). A significant interaction was found between KAP and the percentage of procedures with radial access by centre (P<0.001). KAP was higher by radial versus femoral access in low-radial-volume centres, and lower in high-radial-volume centres. Radiation protection techniques, such as the use of low frame rates (7.5 frame/s), were used more frequently in high-radial-volume radial centres. CONCLUSIONS: In this multicentre study, radial access was associated with lower radiation doses to patient than femoral access in high-radial-volume centres. Provided that radioprotection methods are implemented, radial access could be associated with lower patient radiation exposure.
Authors: Kelly Wilson-Stewart; Davide Fontanarosa; Eva Malacova; Steven Gett; Allan Kruger; Jamie V Trapp Journal: J Multidiscip Healthc Date: 2021-07-12