Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient‐Level, International, Collaborative, Multi‐Center Analysis
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abstract
Background
The adoption of the transradial (
TR
) approach over the traditional transfemoral (
TF
) approach has been hampered by concerns of increased radiation exposure—a subject of considerable debate within the field. We performed a patient‐level, multi‐center analysis to definitively address the impact of
TR
access on radiation exposure.
Methods and Results
Overall, 10 centers were included from 6 countries—Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of
TR
versus
TF
access using measured dose‐area product (
DAP
). To account for local variations in equipment and exposure, standardized
TR
:
TF DAP
ratios were constructed per center with procedures separated by coronary angiography (
CA
) and percutaneous coronary intervention (
PCI
). Among 57 326 procedures, we demonstrated increased radiation exposure with the
TR
versus
TF
approach, particularly in the
CA
cohort across all centers (weighted‐average ratios:
CA
, 1.15;
PCI
, 1.05). However, this was mitigated by increasing
TR
experience in the
PCI
cohort across all centers (
r
=−0.8;
P
=0.005). Over time, as a center transitioned to increasing
TR
experience (
r
=0.9;
P
=0.001), a concomitant decrease in radiation exposure occurred (
r
=−0.8;
P
=0.006). Ultimately, when a center's balance of
TR
to
TF
procedures approaches 50%, the resultant radiation exposure was equivalent.
Conclusions
The
TR
approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the
TR
and
TF
approaches are used with equal frequency—a guiding principle for centers adopting the
TR
approach.
