REVERE Trial Compares Effect of Vascular Entry Sites on Radiation Exposure

August 21, 2015—Samir B. Pancholy MD, et al conducted the randomized noninferiority REVERE trial on radiation exposure during cardiac catheterization comparing femoral access (FA) with left radial access (LRA) and right radial access (RRA). The investigators published their findings in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2015;8:1189–1196).

The REVERE investigators concluded that radiation exposure to patients was similar during diagnostic coronary angiography with FA, RRA, and LRA. However, LRA was associated with significantly higher operator radiation exposure than the FA and RRA procedures.

According to the investigators, the REVERE trial randomized 1,493 patients undergoing cardiac catheterization at a tertiary care center to FA, LRA, and RRA in a 1:1:1 fashion. The primary endpoint was air kerma. The secondary endpoints included dose-area product, fluoroscopy time and operator dose per procedure, number of cineangiograms, and number of catheters.

Baseline and procedural characteristics were similar among the groups. No significant differences were observed in air kerma (medians: FA, 421 mGy; LRA, 454 mGy; and RRA, 483 mGy), dose-area product (medians: FA, 25.5 Gy cm^2; LRA, 26.6 Gy cm^2; and RRA, 27.7 Gy cm²), or fluoroscopy time (medians: FA, 1.3 min; LRA, 1.3 min; and RRA, 1.32 min) among the three access sites. Median operator exposure was higher in the LRA group (3 mrem) compared with the FA (2 mrem) and RRA groups (3 mrem), reported the REVERE investigators in JACC: Cardiovascular Interventions.