Impact of a Novel Radiation Protection System on Door-to-Balloon Time During STEMI Intervention

Prolonged radiation exposure remains a critical occupational hazard in the catheterization lab, typically mitigated by lead aprons, which contribute to orthopedic injury. Recent innovations like the Rampart M1128 enhanced radiation protection system (Rampart IC) aim to reduce these risks, but their impact on door-to-balloon (D2B) time in ST-elevation myocardial infarction (STEMI) has not been evaluated.

We conducted a single-center retrospective cohort study comparing D2B times among 174 STEMI patients undergoing percutaneous coronary intervention: 87 treated using lead aprons and 87 treated utilizing the Rampart M1128 system. Patients were randomly selected from a pool of 298. Analyses were adjusted for potential confounders, including bleeding, use of vasopressors, intubation, mechanical support, electrical instability, access type, and prior revascularization.

Unadjusted median D2B time was 31.0 minutes in the Rampart group vs 31.1 minutes in the lead apron group. Adjusted analysis yielded a mean D2B difference of 1.51 minutes (95% CI, -0.86 to 3.87; P = .21), well within the prespecified 5-minute noninferiority margin. No statistically significant differences were observed across expanded models or one-at-a-time covariate models. The presence of shock or respiratory failure did not prolong D2B times in the Rampart group.

Implementation of an enhanced radiation protection system was noninferior to standard lead apron use regarding D2B time in STEMI patients. This suggests such systems can enhance operator safety without compromising the quality of patient care. Broader adoption may be justified to reduce occupational harm while maintaining high-quality cardiovascular outcomes.