Less radiation, more monitoring

The needle recently moved in a positive direction for patients and cardiologists, or at least it showed the potential to do so, with technical and procedural advancements that may reduce radiation exposure and improve monitoring.

A team of interventional cardiologists explored the difference in radiation exposure and comfort for operators who perform transradial PCI using left or right vascular access. The left approach led to a reduction in exposure of nearly half that measured using right access. Operators reported more discomfort with left radial PCI, usually involving obese patients and only during the access period.

Radial PCI is still playing second fiddle to transfemoral PCI in the U.S. but it is gaining traction. Many catheterization labs are set up for right-access procedures, though, and this study may provide evidence for the development of more versatile configurations.

In a separate study, researchers in Michigan showed that by using next-generation CT imaging technology, they could slice radiation dose in patients scanned for coronary artery disease, pulmonary embolism and aortic disease. The multicenter analysis involved 572 patients and its findings gave credence to smaller studies that showed benefits using advanced scanning technology.

On another front, the New England Journal of Medicine published two randomized trials that evaluated longer-term monitoring of patients with cryptogenic stroke to detect atrial fibrillation. Standard care includes a 24-hour vigil, a window that may not capture paroxysmal atrial fibrillation. Without proof of atrial fibrillation, cardiologists are unlikely to prescribe anticoagulants as a prevention for secondary stroke.

One study, EMBRACE, found that the use of 30-day electrocardiographic monitoring was superior to use of a 24-hour Holter monitor; 16.1 percent of patients with prolonged monitoring had atrial fibrillation while standard monitoring spotted it in only 3.2 percent of patients. Prolonged monitoring led to almost double the proportion of patients prescribed an anticoagulant.

The second trial, CRYSTAL AF, assessed the use of an insertable cardiac monitor compared with standard care in patients with cryptogenic stroke. The insertable device was more likely to spot atrial fibrillation: at six months, it had a detection rate of 8.9 percent vs. 1.4 percent and at 12 months, 12.4 percent vs. 2 percent.

This isn’t a shoo-in for any of these new technologies and approaches, but demonstrating feasibility and effectiveness go a long way toward acceptance by providers and payers. That is a must to get them integrated into practice and making a difference in safety and outcomes.  

Candace Stuart

Cardiovascular Business, editor