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Interventional cardiology will be in the spotlight during TCT 2025 in San Francisco and amongst the Featured Clinical Research are presentations looking at outcomes in patients following coronary procedures and the risk of radiation for operators.

A substudy from the randomized FAME 3 trial, simultaneously published in JACC, found that PCI was more cost-effective than CABG in 1,500 patients with three-vessel coronary artery disease, while quality-adjusted life-years were similar at five years in the two groups (4.05 vs. 4.03, respectively). PCI was guided by fractional flow reserve and zotarolimus drug-eluting stents were implanted.

Researchers reported that cumulative costs over five years were 30% higher in patients randomized to CABG ($36,990 vs. $25,667 for PCI; p<0.001).

No significant difference was observed for all-cause mortality or for a composite outcome of mortality, myocardial infarction or stroke. More patients who were younger than 65 when they had a CABG vs. PCI were still working at five years (56% vs. 47%).

“The equal survival rates at five-years in FAME 3 means there was no long-term survival benefit from CABG to justify its substantially higher costs, which is the main reason we found PCI to be the more cost-effective alternative, both at five years and in lifetime projections,” write study investigators Mark A. Hlatky, MD, FACC; Victoria Ding, MS; et al.

The DOSE study, simultaneously published in JACC: Cardiovascular Interventions, found no significant differences in the amount of radiation exposure of operators who used a strategy of left distal radial access (DRA) vs. right transradial access (TRA) during coronary procedures.

Conducted at three sites in South Korea, this prospective, open-label trial randomized patients who were undergoing a coronary procedure to DRA (n=501) or right TRA (n=500).

The radiation dose in the left DRA and right TRA groups was 4.76 vs. 5.20 μSv (p=0.342) measured at the left wrist, 2.00 vs. 1.83 μSv (p=0.416) measured at the head and 1.28 vs. 1.07 μSv (p=0.199) measured at the chest.

Looking a secondary endpoints, investigators found no significant differences in the incidence of crossover (6.6% vs. 5.2%), fluoroscopy time (4.5 vs. 4.2 min), procedure time (16.0 vs. 15.0 min) or contrast volume (80 Ml for both).

“The present study is of particular significance in that it provides direct evidence that left DRA does not increase radiation exposure compared to right TRA,” write study authors Oh-Hyun Lee, MD; Ji Woong Roh, MD, PhD, et al. “This finding suggests that radiation hazard should not be considered a limiting factor for the adoption of left DRA in routine clinical practice.”

Clinical Topics:
Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease

Keywords:
Transcatheter Cardiovascular Therapeutics, TCT25, Drug-Eluting Stents, Fractional Flow Reserve, Myocardial, Coronary Artery Disease, Percutaneous Coronary Intervention, Myocardial Infarction, Stroke, Coronary Artery Bypass