Research Fellow Minneapolis Heart Institute Foundation Minneapolis Heart Institute Foundation Minneapolis, Minnesota
Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be associated with increased risk of excessive radiation.
Methods: We examined radiation dose in 5,635 patients undergoing CTO PCI at 28 US and international centers between 2012 and 2019. We compared the group of patients that had fluoroscopy area kerma (AK) radiation dose above the median (>2.4 Gy) and those who had AK radiation dose below the median (≤2.4 Gy).
Results: Mean age was 64.5 ±10 years and 83% of patients were men. Median AK radiation dose was 2.4 [1.3-4.1] Gy. The proportion of procedures that had AK dose >2.4 Gy decreased over time (Figure, Panel A). Median AK radiation dose was significantly lower in 2019 vs. 2012 (1.9 [1.1, 3.2] vs. 4.4 [2.5, 6.2] Gray, p<0.0001) (Figure, Panel B). Median body mass index was higher in the higher radiation group (31.4 [27.9, 35.8] vs 28.4 [25.5, 32.3], p<0.0001). Patients in the higher radiation dose group were more likely to have previous coronary artery bypass graft surgery compared with patients in the lower radiation group (41% vs. 28%, p<0.0001). Median J-CTO score (3 [2,4] vs. 2 [1, 3], p<0.0001) and median procedure time (167 [119,223] vs. 104 [72,143] min, p<0.0001) were higher in the higher radiation group. Technical and procedural success were lower in the higher radiation group (84% vs. 91%, 82% vs. 90%, respectively, p<0.0001) and the incidence of in-hospital major adverse cardiovascular events was higher (3.3% vs. 1.7%, p=0.0025). There was no reported radiation skin injury.
Conclusion: AK radiation dose during CTO-PCI has significantly decreased in recent years among high-volume, experienced centers.