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

Georgios E. Christakopoulos, Georgios Christopoulos, Dimitri Karmpaliotis, Khaldoon Alaswad, Robert W. Yeh, Farouc A. Jaffer, Michael R. Wyman, William L. Lombardi, Muhammad Nauman J Tarar, J. Aaron Grantham, David E. Kandzari, Nicholas Lembo, Jeffrey W. Moses, Ajay J. Kirtane, Manish Parikh, Philip Green, Matthew Finn, Santiago Garcia, Anthony H. Doing, Raja HatemCraig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury. Methods 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. Results 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. Conclusions 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.

Original languageEnglish (US)
Pages (from-to)478-484
Number of pages7
JournalCanadian Journal of Cardiology
Volume33
Issue number4
DOIs
StatePublished - Apr 1 2017

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry'. Together they form a unique fingerprint.

  • Cite this

    Christakopoulos, G. E., Christopoulos, G., Karmpaliotis, D., Alaswad, K., Yeh, R. W., Jaffer, F. A., Wyman, M. R., Lombardi, W. L., Tarar, M. N. J., Grantham, J. A., Kandzari, D. E., Lembo, N., Moses, J. W., Kirtane, A. J., Parikh, M., Green, P., Finn, M., Garcia, S., Doing, A. H., ... Brilakis, E. S. (2017). Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry. Canadian Journal of Cardiology, 33(4), 478-484. https://doi.org/10.1016/j.cjca.2016.11.002