Is Dual-Axis Rotational Coronary Angiography Radiation Dose Reduction Achievable in a Population with 100% Suspected Coronary Artery Disease? A Randomized Trial

Abstract

BackgroundPrevious studies have shown a reduction in radiation dose and contrast volume using dual-axis rotational coronary angiography (DARCA), but this has not been replicated in a population with 100% coronary artery disease (CAD). ObjectiveTo find if DARCA dose reduction is achievable in this population, we sought to compare the radiation dose, contrast volume, and procedure time between DARCA and conventional coronary angiography (CCA) techniques in a setting characterized by a prevalence of 100% suspected coronary artery disease. MethodsAn all-comer, prospective, randomized, open-label trial was conducted. Cine acquisition dose–area product (DAP), cumulative air kerma (AK), effective dose (E), fluoroscopic time, contrast volume, AK, cine acquisition DAP (CADAP), fluoroscopic DAP (F-DAP), and total DAP were compared between DARCA and CCA groups. ResultsWe included 503 consecutive patients with suspected CAD. 252 were assigned to DARCA and 251 to CCA. Stable coronary artery disease was reported in 465 cases and non-ST elevation acute coronary syndrome in 38. Mean age: 61.88 ± 11.2 years, male gender 70.2%. DARCA arm patients showed lower total E dose (6.85 [4.55–10.83] vs. 7.91 [5.58–11.94] Sv; P = .0023), and cine E (3.00 [2.00–4.00] vs. 4.00 [3.00–5.00] Sv; P < .0001). Total DAP was also lower (40.3 [26.8–63.7] vs. 46.5 [32.8–70.2] Gycm2; P = .0023), as a consequence of a lower CADAP (16.3 [10.5–22.9] vs. 23.4 [17.4–32.0] Gycm2; P < .0001), with lower AK (367 [248–1497] vs. 497 [381–1827] mGy; P < .0001), with less contrast medium used (90 [60.0–106.0] vs. 100 [75.0–120.0] mL; P = .014). ConclusionIn a population with 100% suspected coronary artery disease, DARCA provides accurate information required in CAD, is safe, and results in a significant decrease in contrast material volume and radiation dose compared with CCA. The required extra projections did not neutralize the DARCA radiation dose and contrast volume reduction achievements.