[Variations of radiation dosage delivered to patients undergoing interventional cardiological procedures. A monocentric study 2002-05]. / Variations des doses de rayonnements délivrées au patient en cardiologie interventionnelle. Etude monocentrique 2002-2005.

X-ray exposure of patient during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) may have some deleterious effects. The dose area product (DAP), related to the effective dose, is a measure of stochastic risk and a potential quality indicator. The aim of our study was to assess radiation exposure of patients in a large series of "real life" interventional cardiac procedures. We evaluated DAP and Fluoroscopy time (t) during CA and/or PTCA in 3600 consecutive patients from 2002 to 2005. Procedures were performed by five experienced physicians, using successively femoral and radial techniques. DAP and t significantly correlated (r = 0.73; p < 0.0001). Median [25th-75th percentiles] values for DAP and for t were 63 [40-101] Gy.cm2 and 6.3 [4-10] min for CA, 100 [62-178] Gy.cm2 and 14.0 [9-22] min for elective PTCA, and 141 [90-219] Gy.cm2 and 15.7 [11-23] min for CA immediately followed by ad hoc PTCA, respectively. Differences between operators ranged from 50% (CA) to 70% (PTCA) for both DAP and t (p < 0.001). Moving from the femoral to the radial approach resulted in a 1.5 to 2-fold increase in DAP in 2002 (p < 0.001). DAP and t then decreased toward the european DIMOND reference values (in 2005: 53.4 Gy.cm2 and 5.5 min for CA, 104.64 Gy.cm2 and 13.1 min for elective PTCA, 128.4 Gy.cm2 and 13.6 min for ad hoc PTCA). In conclusion, radiation exposure to patients and staff are strongly dependent on operators, time course, and the arterial access, due in part to the learning curve for radial approach. The enhanced knowledge of radiation dose is the first step of a radiation dose-reduction program, likely to minimize patient and operator radiation hazards in interventional cardiology. Definition of national reference values for DAP and fluoroscopy time would be helpful for appropriate comparisons.

[Use and limitations of invasive coronary strategy in nonagerians]. / Intérêts et limites de la stratégie invasive coronaire chez les patients nonagénaires.

BACKGROUND: Nonagenarians are systematically excluded from studies of interventional cardiology. Few data exist on the usefulness, safety, and results of coronary angiography (CA) and percutaneous coronary intervention (PCI) in this population. PURPOSE: To evaluate the benefits and hazards of CA and PCI in nonagenarians. METHODS: Retrospective study conducted from the database (Cardioreport(®)) of the CH de Versailles, from January 2001 to December 2011. RESULTS: From the 15,806 procedures performed in the center during the period, 107 (0.9%) were done in 97 patients aged ≥90years. Half of them underwent PCI. Median age was 92±2years (range: 90 to 100), 56% were women. Main indication was an acute coronary syndrome (77%, acute STEMI in 39%). The first group (n=58) had a single CA leading to strengthen medical treatment, and CABG in one case. The second group (n=49) had a CA followed by immediate (41) or delayed (8) PCI. The primary success rate of PCI was 90%. Radial route was used in 94% in the period 2009-2011 (51% overall). Failure of arterial access (4%) and difficulties of catheterization (13%) were rare. Severe complications occurred in 19%. They were local (11 hematomas, 6 severe, 4 transfusions, and 1 fatal acute ischemia of a lower limb), and general (1 stroke, 1 death by left main rupture during PCI). Twenty percent of the complications (11% of severe ones) were directly related to the procedure. Overall hospital mortality was 10%. CONCLUSIONS: Angiography is feasible in nonagenarians by radial approach without failures and with a reduced rate of complications. PCI was indicated in about half of the cases. PCI may be proposed in nonagerians with a high success rate, and an acceptable risk of local and general complications.