[Impact of rotational coronary angiography in the amount of iodinated contrast and the exposure to ionising radiations in patients undergoing invasive coronary procedures: A systematic review and meta-analysis]

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.

Keywords: Angiografía coronaria; Angiografía coronaria rotacional; Angioplastia coronaria; Coronary angiography; Coronary angioplasty; España; Meta-analysis; Metaanálisis; Revisión sistemática; Rotational coronary angiography; Spain; Systematic review.