ABSTRACT
Resumen Antecedentes: Los procedimientos coronarios invasivos conllevan la administración de contraste y la exposición a radiaciones ionizantes, comportando un incremento de la morbimortalidad. La angiografía coronaria rotacional (ACR) permite adquirir múltiples proyecciones con una inyección de contraste. Hasta la fecha, no hay metaanálisis específicos comparando la ACR y la angiografía coronaria convencional (ACC) en pacientes en los que se realizan procedimientos coronarios invasivos, tanto diagnósticos como diagnósticos y terapéuticos. El objetivo de este metaanálisis es evaluar el impacto de la ACR en la cantidad de contraste, y la radiación ionizante en procedimientos coronarios invasivos. Métodos: Se realizó una búsqueda en las bases de datos PubMed y Ovid para identificar estudios tanto diagnósticos como diagnósticos y terapéuticos que comparasen ACR y ACC. Los estudios fueron evaluados sobre la calidad y los sesgos, y fueron incluidos si contemplaban alguna de las siguientes variables de valoración: volumen de contraste, radiación ionizante medida como producto dosis-área, Kerma-aire o tiempo de fluoroscopia. Resultados: Dieciséis estudios, totalizando 2,327 pacientes, fueron incluidos en el análisis final (1,146 pacientes recibieron ACR y 1,181, ACC), objetivándose diferencias significativas en volumen de contraste (diferencia estándar de medias (intervalo de confianza al 95%) −1.887 (−2.472 a −1.302); p < 0.001), producto dosis-área (−0.726 (−1.034 a −0.418); p < 0.001), Kerma-aire (−0.842 (−1.104 a −0.581); p < 0.001) y tiempo de fluoroscopia (0.263 (−0.496 a −0.030); p = 0.027). Conclusiones: La ACR permite reducir el volumen de contraste y la radiación, evaluada como producto dosis-área, Kerma-aire y tiempo de fluoroscopia en pacientes a los que se les realizan procedimientos coronarios invasivos.
Abstract Background: Invasive coronary procedures involve the administration of iodinated contrast and the exposure to ionising radiations, increasing morbidity and mortality. The rotational coronary angiography (RCA) allows acquiring multiple projections with a unique injection of iodinated contrast. To date, there are no meta-analyses specifically comparing RCA and conventional coronary angiography (CCA) in patients undergoing invasive coronary procedures, whether diagnostic or diagnostic and therapeutic. The aim of this meta-analysis is to assess the impact of RCA on the amount of iodinated contrast and the exposure to ionising radiations during invasive coronary procedures. Methods: A search in PubMed and Ovid databases was conducted to identify studies, including diagnostic and diagnostic and therapeutic studies, comparing RCA and CCA. The manuscripts were evaluated on quality and biases, and were included if they analysed any of the following endpoints: volume of contrast and exposure to ionising radiations measured as dose-area product, and Kerma-air or fluoroscopy time. Results: Sixteen studies, with a total of 2,327 patients, were included in the final analysis (1,146 patients underwent RCA and 1,181 patients underwent CCA), with significant differences being detected in volume of contrast (standard difference in means (95% confidence interval) −1.887 (−2.472 to −1.302); P < .001), dose-area product (−0.726 (−1.034 to −0.418); P < .001), Kerma-air (−0.842 (−1.104 to −0.581); P < .001), and fluoroscopy time (0.263 (−0.496 to −0.030); P = .027). Conclusions: RCA reduces the volume of contrast and the exposure to radiation, evaluated as dose-area product, Kerma-air, and fluoroscopy time, in patients undergoing invasive coronary procedures.
Subject(s)
Humans , Coronary Artery Disease/diagnostic imaging , Coronary Angiography/methods , Contrast Media/administration & dosage , Radiation, Ionizing , Fluoroscopy , Iodine Compounds/administration & dosageABSTRACT
Objective To evaluate the clinical safety and feasibility of dual-axis rotational coronary angiography (XperSwing) in diagnosing coronary artery disease in aged Chinese patients through comparing it with standard coronary angiography. Methods During the period from April 2011 to December 2012, a total of consecutive 151 patients with an age ≥ 65 years underwent diagnostic coronary angiography at authors’ hospital. The patients were randomly divided into the standard angiography group (n = 75) and XperSwing group (n = 76). The used dose of contrast, radiation exposure dose and operation time of each patient were recorded. Besides, the occurrence of procedure-related symptoms and arrhythmia during the procedure was recorded, and the blood pressure (BP), heart rate (HR) and creatinine level immediately before-and-after the procedure were estimated. The number of additional acquisition needed to be performed was used to evaluate the efficacy of the two methods. Results Coronary angiography was successfully accomplished in all patients of the two groups, and no significant difference in the number of additional acquisition existed between the two groups (P > 0.05). The used dose of contrast in XperSwing group was reduced by 44% when compared with that in the standard angiography group, i.e. (29.28 ± 5.06) ml vs(22 755.97 ± 11 239.22) mGycm2, (P 0.05). No contrast- induced nephropathy occurred in both groups, although the difference in postoperative changes of creatinine level between the two groups was statistically significant (P < 0.05). Conclusion This study indicates that in diagnosing coronary artery disease in aged Chinese patients, dual-axis rotational coronary angiography is more safe and effective than conventional coronary angiography, as XperSwing can significantly reduce the contrast dose and radiation exposure for the patients.