Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RAD-Matrix Trial.
BACKGROUND
It remains unclear whether radial access increases the risk of operator or patient radiation exposure compared to transfemoral access when performed by expert operators.


OBJECTIVE
This study sought to determine whether radial access increases radiation exposure.


METHODS
A total of 8,404 patients, with or without ST-segment elevation acute coronary syndrome, were randomly assigned to radial or femoral access for coronary angiography and percutaneous intervention, and collected fluoroscopy time and dose-area product (DAP). RAD-MATRIX is a radiation sub-study of the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) trial. We anticipated that 13 or more operators, each wearing a thorax (primary endpoint), wrist, and head (secondary endpoints) lithium fluoride thermoluminescent dosimeter, and randomizing at least 13 patients per access site, were needed to establish noninferiority of radial versus femoral access.


RESULTS
Among 18 operators, performing 777 procedures in 767 patients, the noninferiority primary endpoint was not achieved (p value for noninferiority = 0.843). Operator equivalent dose at the thorax (77 μSv) was significantly higher with radial than femoral access (41 μSv; p = 0.02). After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ for right radial (84 μSv) compared to left radial access (52 μSv; p = 0.15). In the overall MATRIX population, fluoroscopy time and DAP were higher with radial compared to femoral access: 10 min versus 9 min (p < 0.0001) and 65 Gy·cm2versus 59 Gy·cm2(p = 0.0001), respectively.


CONCLUSIONS
Compared to femoral access, radial access is associated with greater operator and patient radiation exposure when performed by expert operators in current practice. Radial operators and institutions should be sensitized towards radiation risks and adopt adjunctive radioprotective measures. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX; NCT101433627).
Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy.
Alessandro
A
Sciahbasi
Eustrategy Association, Forlì, Italy.
Enrico
E
Frigoli
Department of Radiation Protection, HSE Management, Rome, Italy.
Alessandro
A
Sarandrea
CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Martina
M
Rothenbühler
Department of Cardio-Thoracic Sciences, Second University of Naples, Naples, Italy.
Paolo
P
Calabrò
Cardiology, ASL VCO, Domodossola, Italy.
Alessandro
A
Lupi
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Francesco
F
Tomassini
Interventional Cardiology, Fatebenefratelli Hospital, Milan, Italy.
Bernardo
B
Cortese
Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy.
Stefano
S
Rigattieri
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
Enrico
E
Cerrato
Humanitas Research Hospital, IRCCS, Rozzano, Italy.
Dennis
D
Zavalloni
Interventional Cardiology Unit, IRCCS AOU San Martino, IST, Genova, Italy.
Antonio
A
Zingarelli
Cardiology Unit, Misericordia Hospital, Grosseto, Italy.
Paolo
P
Calabria
Villa Scassi Hospital, Genova, Italy.
Paolo
P
Rubartelli
Department of Cardiovascular Sciences, Policlinico Umberto I, Rome, Italy.
Gennaro
G
Sardella
Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy.
Matteo
M
Tebaldi
Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Stephan
S
Windecker
CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Peter
P
Jüni
CTU Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Dik
D
Heg
Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. Electronic address: marco.valgimigli@insel.ch.
Marco
M
Valgimigli
D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016273:Occupational Exposure / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery; D000069079:Radiation Exposure / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D012308:Risk Management / Q000458:organization & administration; D013997:Time Factors
femoral access; percutaneous coronary intervention; radial access; radiation dose