Title : A comparative study of fixed fluoroscopy-assisted and portable c-arm-assisted coronary catheterization and intervention: Evaluating procedural outcomes and radiation exposure
Abstract:
Background: Approximately 20.1 million adults in the United States are affected by coronary artery disease. Every year over 4 million coronary angiograms are being performed in Europe and the USA. Over 1700 cardiac catheterization laboratories were present across the United States. It is not uncommon to observe repairs of cath lab fluoroscopy equipment, which can impact the workflow in hospitals and, consequently, patient care. Portable C-arms are widely accessible in many hospitals, providing temporary assistance in conducting coronary procedures. The radiation effects and procedural outcomes of C-arm assisted coronary angiogram compared to fluoroscopic assisted coronary procedures remain unknown.
Methods: From August 2023 to November 2023, we conducted an assessment involving 89 patients who underwent coronary angiograms and interventions. Our analysis encompassed a comparison of demographics, total entrance skin dose (mGy), total fluoroscopy time, total intravenous contrast use, periprocedural complications, successful door-to-balloon time for ST-elevation MI, and mortality associated with coronary catheterizations performed using fixed cath lab fluoroscopy versus portable C-arm fluoroscopy.
Results: A total of 89 patients were included for analysis. Among them, 60 coronary angiograms were performed with fixed cath lab fluoroscopy, and 29 coronary angiograms were performed through portable C-arm fluoroscopy. Baseline demographics showed patients who underwent angiograms with portable C-arm had more diabetes and chronic kidney disease. There were no significant differences in age, hypertension, hyperlipidemia, history of stroke, history of MI, acute coronary syndrome, ST-elevation MI presentation, and radial access between the two groups (table). There was a significantly low total entrance skin dose in patients who underwent angiogram with portable C-arm compared to fixed cath lab fluoroscopy (584 mGy vs 1736 mGy; p=0.001) (picture). There was no significant difference in total fluoro time, total contrast use, patients who underwent PCI, perioperative cardiac arrest, stroke before the discharge, mortality, or successful door-to-balloon time less than 90 min for STEMI in between groups. One patient died in a fixed cath lab fluoroscopy group for acute coronary syndrome and cardiogenic shock. There were six patients in the fixed cath lab fluoroscopy and four patients in the portable C-arm group who underwent revascularization for STEMI.
Conclusion: Portable C-arm fluoroscopy demonstrates a reduced total entrance skin dose in comparison to fixed cath lab fluoroscopy. This alternative may prove valuable in emergency cath lab procedures when regular fixed fluoroscopy is unavailable, offering a potential solution without compromising patient safety.
