Laurent Faroux

Minimizing exposure to radiation in invasive cardiology using modern dose-reduction technology: evaluation of the real-life effects

We aimed to measure the reduction in the estimated dose of radiation received by patients that can be achieved using dose‐reduction technology (ClarityIQ, Philips Healthcare, The Netherlands), among all patients undergoing invasive cardiology procedures.

Trends in Patient Exposure to Radiation in Percutaneous Coronary Interventions Over a 10-Year Period

Technological progress has made it possible to reduce the dose of radiation delivered by medical x-ray systems. In parallel, interventional coronary procedures have become increasingly complex and consequently, last longer. This study aimed to compare the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs 2016). The study population included all patients who underwent interventional coronary procedures in one of the catheterization laboratories of our institution during 2 periods, namely, period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary end point was the estimated dose of radiation received by the patient as assessed by dose area product. In 2016, the estimated dose of radiation received by patients who underwent interventional coronary procedures was on average 78% lower than that received in 2006 (p <0.0001), whereas the fluoroscopy time increased by 54% on average over the same period (p <0.0001). By multivariate analysis, including age, approach, body mass index, fluoroscopy time, and performance of angioplasty, the reduction in radiation remained significant. The radial approach was significantly associated with an increased estimated dose of radiation received (p <0.0001). In conclusion, the estimated dose of radiation received by patients who underwent interventional cardiology procedures has been reduced by 78% over the last decade.

Effect of Modern Dose-Reduction Technology on the Exposure of Interventional Cardiologists to Radiation in the Catheterization Laboratory

Interventional cardiologists are exposed to deterministic and stochastic effects of ionizing radiation, as evidenced by their increased risk of developing cataracts and left-sided brain tumors, respectively [(1–3)][1]. The ClarityIQ dose-reduction system (Philips Healthcare, Amsterdam, the

Reduction in exposure of interventional cardiologists to ionising radiation over a 10-year period

Exposure of operators to ionising radiation in interventional cardiology has likely diminished, but data confirming the magnitude of the reduction are lacking. The aim of this study was to compare the dose of radiation received by interventional cardiology operators at 11 years interval (2006 vs 2017). The study population comprised all interventional coronary procedures performed by a single operator in one catheterization laboratory (cathlab) of a large university hospital in north-eastern France. Exposure was compared between two periods, namely period 1 (from October 2005 to March 2006) and period 2 (from March 2017 to June 2017). The primary endpoint was the dose of radiation received by the operator, measured using an electronic dosimeter placed on the operators left arm. In 2017, the dose of radiation received by the operators was, on average, 95% lower than the dose received in 2006 (p < 0.0001), even though the average fluoroscopy time increased by 73% over the same period (p < 0.0001). By multivariable analysis including body mass index, fluoroscopy time and performance of at least one (1) coronary angioplasty, the reduction in the operators exposure to radiation remained significant. The dose of radiation received by interventional cardiology operators has decreased by 95% over the last ten years.

Acute coronary syndromes in the very elderly: short term prognostic performance of the SYNTAX score

Acute coronary syndromes (ACS) frequently occur in elderly subjects. The high mortality associated with ACS in this population justifies the identification of factors related to poor prognosis. We aimed to evaluate the short-term prognostic performance of the SYNTAX score in a population of patients aged 85years or more presenting ACS and undergoing coronary angiography. Secondary objectives were to identify factors related to length of stay and potential markers of in-hospital death. We performed a retrospective, single-centre prognostic study including patients aged 85years or more who underwent coronary angiography for ACS over a 4year period. The primary endpoint was length of stay, and the secondary endpoint was in-hospital mortality. In total, 70 patients were included (37 men), average age 87.0±2.5years. Average SYNTAX score was 19.0±14.9. Average length of stay was 13.1±7.8days. By multivariate analysis, SYNTAX score was correlated with length of stay (p=0.008). Seven (10%) patients died in-hospital. Patients who died had a higher SYNTAX score (p=0.013) (threshold value of 25) and a lower left ventricular ejection fraction (p=0.001). They more frequently had signs of heart failure at admission (p=0.002), ST segment elevation ACS (p=0.046) and left main stem involvement (p=0.041) than survivors. In our study, SYNTAX score was associated with length of stay and in-hospital mortality. A SYNTAX score of 25 or more seems to be an indicator of poor short-term prognosis in very elderly patients with ACS.