title: Radial versus femoral access for coronary angiography and intervention is associated with lower patient radiation exposure in high-radial-volume centres: Insights from the RAY'ACT-1 study.
abstract: BACKGROUND
  Literature suggests that radial access is associated with higher radiation doses than femoral access.
  
  
  OBJECTIVE
  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.affiliation: 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.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Georges
authors.affiliation: 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.
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.affiliation: 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.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Meunier
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Jacques-Cœur, 18000 Bourges, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Dechery
authors.affiliation: 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.
authors.forename: Khalifé
authors.initials: K
authors.lastname: Khalifé
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier du Docteur-Schaffner, 62300 Lens, France.
authors.forename: Max
authors.initials: M
authors.lastname: Pecheux
authors.affiliation: 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.
authors.forename: Simon
authors.initials: S
authors.lastname: Elhaddad
authors.affiliation: 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.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Henri-Duffaut, 84000 Avignon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Pansieri
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Hôpital Pierre-Bérégovoy, 58000 Nevers, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Ballout
authors.affiliation: 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.
authors.forename: Xavier
authors.initials: X
authors.lastname: Marchand
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Intercommunal de Cornouaille, 29107 Quimper, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rouault
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier d'Haguenau, 67500 Haguenau, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Leddet
authors.affiliation: 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.
authors.forename: Olivier
authors.initials: O
authors.lastname: Nugue
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France; Service de Cardiologie, Centre Hospitalier Général Girac-Angoulême, 16959 Angoulême, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lucke
authors.affiliation: Service de Cardiologie, Centre Hospitalier Intercommunal de Le Raincy-Montfermeil, 93370 Montfermeil, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Cattan
authors.affiliation: Collège National des Cardiologues des Hôpitaux, Société Française de Cardiologie, 75011 Paris, France.
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005602:France; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061214:Patient Safety; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D057216:Propensity Score; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Angioplastie coronaire; Coronarographie; Coronary angiography; Kerma-area product; Percutaneous coronary intervention; Produit dose-surface; Radial access; Radiation protection; Radioprotection; Voie radiale