MDNews - Greater Boston

By Rachel Stewart Elevated Radiation Exposure Prior to PCI Linked to Patient Factors A RECENT STUDY SHOWS CERTAIN PATIENT FACTORS COULD RAISE RADIATION EXPOSURE RISK DURING PERCUTANEOUS CORONARY INTERVENTION (PCI) MORE SO THAN THE SURGICAL APPROACH ITSELF. T HE STUDY WAS conducted by a team at the Department of Cardiology at the University of Amsterdam. Experts reviewed patient data from the Swedish Coronary Angiography and Angioplasty Registry for 20,669 patients undergoing coronary angiography and PCI procedures at fi ve centers in western Sweden. From Jan. 1, 2008, to Jan. 19, 2012, 10,819 patients underwent coronary angiography and 9,850 underwent PCI at Sahlgrenska University Hospital, Ostra Hospital, Norra Alvborgs Hospital, Sodra Alvborg Hospital and Skaraborg Hospital Shovde. A previous paper published by the International Commission on Radiological Protection suggested that patients who underwent procedures utilizing fl uoroscopy were at greater risk for cancer later in life. With the radial approach to coronary angiography and PCI offering specialists more options to assess and treat cardiovascular disease, the research team set out to see if the procedure also played a role in exposing patients unnecessarily to radiation. Researchers also took into account what technology was being used in each catheterization laboratory as well as safeguards to shield patients from radiation exposure. Researchers reviewed radiation exposure in dose-area product meters as well as fl uoroscopy times to determine patient radiation exposure. Approximately 59 percent of the procedures performed utilized the radial approach, with 4 percent of those cases also using the femoral approach. Throughout the study period, researchers noted that radiation exposure actually declined over time. During the course of the study, it became clear that many patients had higher radiation exposure before PCI due to certain risk factors or past treatment history. These factors include: + High body mass index + History of coronary artery bypass grafting + Numerous past lesions requiring treatment + History of chronic lesions Weighing the Risks Depending on a patient's cardiovascular history or higher BMI, specialists may want to determine if PCI is the best treatment, but overall, the study suggests that the radial approach is safe and does not put patients at higher risk. Elmir Omerovic, MD, PhD, Study Investigator at the Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden, noted in Cardiology Today's Intervention that "the radial access route was not associated with increased radiation exposure [which] should encourage more interventionalists to use the radial approach as a standard method for coronary angiography and PCI." To read the full study, "Clinical and Procedural Characteristics Associated With Higher Radiation Exposure During Percutaneous Coronar y Inter ventions and Coronar y Angiography," visit circinterventions.ahajournals.org. ■ CORE M D N E W S . CO M ■ MD NEWS Greater Boston | 9

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