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

Background Literature suggests that radial access is associated with higher radiation doses than femoral access. Aims 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 3.5 minutes [P < 0.001]; PCI, 10.4 vs 10.1 minutes [P = 0.001]), the Kerma-area product (KAP) was lower with radial access (CA, 26.8 vs 28.1 Gy·cm2; PCI, 55.6 vs 59.4 Gy·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.