Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily RouTine (EXPERT) Trial

Overview

Journal Tex Heart Inst J

Specialty Cardiology & Vascular Diseases

Date 2023 Mar 21

PMID 36944120

Authors

Cristiano de Oliveira Cardoso

Claudio Vasques de Moraes

Julio Vinicius Teixeira

Carlos Roberto Cardoso

Felipe Baldissera

Eduardo Ilha de Mattos

Marcio Jose Siqueira

Leandro Fischer

Juliana Canedo Sebben

Bruna Santos Silva

Gabriel Broetto

Carlos Antonio Mascia Gottschall

Rogerio Sarmento-Leite

Affiliations

Soon will be listed here.

Abstract

Background: The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators.

Methods: Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol.

Results: Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38).

Conclusion: TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.

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