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RADMatrix: Physician, patient radiation exposure during PCI higher with transradial access vs. transfemoral access

WASHINGTON — Transradial access was linked to higher operator and patient radiation vs. transfemoral access during PCI, suggesting radioprotective measures are needed, according to the results of a study presented at the American College of Cardiology Scientific Session.

“Recently a large meta-analysis comparing the transradial and transfemoral access showed that the transradial access is associated with a small but significant increase in radiation exposure,” Alessandro Sciahbasi, MD, PhD, interventional cardiologist from Sandro Pertini Hospital in Rome, said during a presentation. “The clinical significance of this small increase is uncertain, particularly considering the advantage in terms of reduced bleeding and vascular complication with transradial access.”

In the MATRIX study, 8,404 patients with or without ST-segment elevation ACS were randomly assigned to transradial or transfemoral access for coronary angiography and PCI.

The RADMatrix substudy included 18 operators from the MATRIX study wearing a lithium fluoride thermoluminescent dosimeter on their thorax, wrist and head who performed 777 procedures on 767 patients.

The primary endpoint was operator radiation exposure at the thorax. Secondary endpoints were operator radiation exposure at the wrist and head. Fluoroscopy time and dose area product were compared. The researchers hypothesized that transradial access would be noninferior to transfemoral access for the primary endpoint.

The noninferiority endpoint of the study was not reached (mean difference, 34.34 Sv with an upper 95% confidence limit of 49.57; P for noninferiority = .843).

Thorax operator equivalent dose at thorax was significantly higher in transradial access compared with transfemoral (transradial, 77 Sv; interquartile range [IQR], 40-112; transfemoral, 41 Sv; IQR: 23-59; P = .02).

After normalization of operator radiation dose by fluoroscopy time or dose area product, the difference remained significant. Radiation dose at wrist or head did not differ between transradial and transfemoral access.

There was no significant difference in the right compared with left transradial access in operator dose to the thorax (right, 84 Sv; IQR, 47-146; left, 52 Sv; IQR, 33-92; P = .15).

Fluoroscopy time (transradial, 10 minutes; IQR, 6-16; transfemoral, 9 minutes; IQR, 5-15; P < .0001) and dose area product (transradial, 65 Gy*cm2; IQR, 29-120; transfemoral, 59 Gy*cm2, IQR, 26-110; P = .0001) were higher with transradial access group.

“According to our data, transradial access is associated with an increased dose for the operator and for the patient, compared to transfemoral access," Sciahbasi said. “Transradial operators should be engaged toward a reduction of radiation dose and adopt additional transradial protective measures.”by Dave Quaile

Reference:

Sciahbasi A, et al. Featured Clinical Research II. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Sciabasi A, et al. J Am Coll Cardiol. 2017;doi:10.1016/j.jacc.2017.03.018

Disclosure: Sciahbasi reports no relevant financial disclosures.

 

WASHINGTON — Transradial access was linked to higher operator and patient radiation vs. transfemoral access during PCI, suggesting radioprotective measures are needed, according to the results of a study presented at the American College of Cardiology Scientific Session.

“Recently a large meta-analysis comparing the transradial and transfemoral access showed that the transradial access is associated with a small but significant increase in radiation exposure,” Alessandro Sciahbasi, MD, PhD, interventional cardiologist from Sandro Pertini Hospital in Rome, said during a presentation. “The clinical significance of this small increase is uncertain, particularly considering the advantage in terms of reduced bleeding and vascular complication with transradial access.”

In the MATRIX study, 8,404 patients with or without ST-segment elevation ACS were randomly assigned to transradial or transfemoral access for coronary angiography and PCI.

The RADMatrix substudy included 18 operators from the MATRIX study wearing a lithium fluoride thermoluminescent dosimeter on their thorax, wrist and head who performed 777 procedures on 767 patients.

The primary endpoint was operator radiation exposure at the thorax. Secondary endpoints were operator radiation exposure at the wrist and head. Fluoroscopy time and dose area product were compared. The researchers hypothesized that transradial access would be noninferior to transfemoral access for the primary endpoint.

The noninferiority endpoint of the study was not reached (mean difference, 34.34 Sv with an upper 95% confidence limit of 49.57; P for noninferiority = .843).

Thorax operator equivalent dose at thorax was significantly higher in transradial access compared with transfemoral (transradial, 77 Sv; interquartile range [IQR], 40-112; transfemoral, 41 Sv; IQR: 23-59; P = .02).

After normalization of operator radiation dose by fluoroscopy time or dose area product, the difference remained significant. Radiation dose at wrist or head did not differ between transradial and transfemoral access.

There was no significant difference in the right compared with left transradial access in operator dose to the thorax (right, 84 Sv; IQR, 47-146; left, 52 Sv; IQR, 33-92; P = .15).

Fluoroscopy time (transradial, 10 minutes; IQR, 6-16; transfemoral, 9 minutes; IQR, 5-15; P < .0001) and dose area product (transradial, 65 Gy*cm2; IQR, 29-120; transfemoral, 59 Gy*cm2, IQR, 26-110; P = .0001) were higher with transradial access group.

“According to our data, transradial access is associated with an increased dose for the operator and for the patient, compared to transfemoral access," Sciahbasi said. “Transradial operators should be engaged toward a reduction of radiation dose and adopt additional transradial protective measures.”by Dave Quaile

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Reference:

Sciahbasi A, et al. Featured Clinical Research II. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Sciabasi A, et al. J Am Coll Cardiol. 2017;doi:10.1016/j.jacc.2017.03.018

Disclosure: Sciahbasi reports no relevant financial disclosures.

 

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