Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry

• Published in: Canadian journal of cardiology 2017-04, Vol.33 (4), p.478-484
• Main Authors: Christakopoulos, Georgios E., Christopoulos, Georgios, Karmpaliotis, Dimitri, Alaswad, Khaldoon, Yeh, Robert W., Jaffer, Farouc A., Wyman, Michael R., Lombardi, William L., Tarar, Muhammad Nauman J., Grantham, J. Aaron, Kandzari, David E., Lembo, Nicholas, Moses, Jeffrey W., Kirtane, Ajay J., Parikh, Manish, Green, Philip, Finn, Matthew, Garcia, Santiago, Doing, Anthony H., Hatem, Raja, Thompson, Craig A., Banerjee, Subhash, Brilakis, Emmanouil S.
• Format: Article
• Language: English
• Subjects: Aged; Chronic Disease; Coronary Angiography - adverse effects; Coronary Occlusion - diagnosis; Coronary Occlusion - surgery; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Radiation Exposure - adverse effects; Radiation Injuries - diagnosis; Radiation Injuries - epidemiology; Registries; Retrospective Studies; Risk Factors; Time Factors; United States - epidemiology
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2016.11.002

High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury. We examined the association between several clinical and angiographic variables on patient air kerma (AK) radiation dose among 748 consecutive CTO PCIs performed at 9 experienced US centres between May 2012 and May 2015. The mean age was 65 ± 10 years, 87% of patients were men, and 35% had previous coronary artery bypass graft surgery (CABG). Technical and procedural success was 92% and 90%, respectively. The median patient AK dose was 3.40 (interquartile range, 2.00-5.40) Gy and 34% of the patients received > 4.8 Gy (high radiation exposure). In univariable analysis male sex (P = 0.016), high body mass index (P < 0.001), history of hyperlipidemia (P = 0.023), previous CABG (P < 0.001), moderate or severe calcification (P < 0.001), tortuosity (P < 0.001), proximal cap ambiguity (P = 0.001), distal cap at a bifurcation (P = 0.006), longer CTO occlusion length (P < 0.001), blunt/no blunt stump (P < 0.001), and centre (P < 0.001) were associated with higher patient AK dose. In multivariable analysis high body mass index (P < 0.001), previous CABG (P = 0.005), moderate or severe calcification (P = 0.005), longer CTO occlusion length (P < 0.001), and centre (P < 0.001) were independently associated with higher patient AK dose. Approximately 1 in 3 patients who undergo CTO PCI receive high AK radiation dose (> 4.8 Gy). Several baseline clinical and angiographic characteristics can help predict the likelihood of high radiation dose and assist with intensifying efforts to reduce radiation exposure for the patient and the operator. La forte dose de rayonnement délivrée aux patients durant l’intervention coronarienne percutanée (ICP) pour occlusion totale chronique (OTC) entraînerait l’échec de l’intervention et des radiolésions de la peau. Nous avons examiné l’association entre plusieurs variables cliniques et angiographiques sur la dose de rayonnement, le kerma dans l’air (KA), délivrée aux patients parmi 748 ICP pour OTC réalisées dans 9 centres qualifiés des É.-U. entre mai 2012 et mai 2015. L’âge moyen était de 65 ± 10 ans, 87 % des patients étaient des hommes, et 35 % avaient déjà subi un pontage aortocoronarien (PAC). La réussite sur le plan technique et sur le plan interventionnel était respectivement de 92 % et 90 %. Bien que la dose médiane de KA délivrée aux patients était de 3,40 (intervalle