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 Hatem & 3 others Craig A. Thompson, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

4 Citations (Scopus)

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)
JournalCanadian Journal of Cardiology
DOIs
StateAccepted/In press - Jul 20 2016

Fingerprint

Coronary Occlusion
Registries
Radiation
Air
Radiation Dosage
Radiation Injuries
Percutaneous Coronary Intervention
Coronary Artery Bypass
Radiation Exposure
Body Mass Index
Transplants
Skin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: Canadian Journal of Cardiology, 20.07.2016.

Research output: Contribution to journalArticle

Christakopoulos, GE, Christopoulos, G, Karmpaliotis, D, Alaswad, K, Yeh, RW, Jaffer, FA, Wyman, MR, Lombardi, WL, Tarar, MNJ, Grantham, JA, Kandzari, DE, Lembo, N, Moses, JW, Kirtane, AJ, Parikh, M, Green, P, Finn, M, Garcia, S, Doing, AH, Hatem, R, Thompson, CA, Banerjee, S & Brilakis, ES 2016, 'Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry', Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2016.11.002
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. / Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention : Insights From a Contemporary Multicentre Registry. In: Canadian Journal of Cardiology. 2016.
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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.",
author = "Christakopoulos, {Georgios E.} and Georgios Christopoulos and Dimitri Karmpaliotis and Khaldoon Alaswad and Yeh, {Robert W.} and Jaffer, {Farouc A.} and Wyman, {Michael R.} and Lombardi, {William L.} and Tarar, {Muhammad Nauman J} and Grantham, {J. Aaron} and Kandzari, {David E.} and Nicholas Lembo and Moses, {Jeffrey W.} and Kirtane, {Ajay J.} and Manish Parikh and Philip Green and Matthew Finn and Santiago Garcia and Doing, {Anthony H.} and Raja Hatem and Thompson, {Craig A.} and Subhash Banerjee and Brilakis, {Emmanouil S.}",
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T1 - Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention

T2 - Insights From a Contemporary Multicentre Registry

AU - Christakopoulos, Georgios E.

AU - Christopoulos, Georgios

AU - Karmpaliotis, Dimitri

AU - Alaswad, Khaldoon

AU - Yeh, Robert W.

AU - Jaffer, Farouc A.

AU - Wyman, Michael R.

AU - Lombardi, William L.

AU - Tarar, Muhammad Nauman J

AU - Grantham, J. Aaron

AU - Kandzari, David E.

AU - Lembo, Nicholas

AU - Moses, Jeffrey W.

AU - Kirtane, Ajay J.

AU - Parikh, Manish

AU - Green, Philip

AU - Finn, Matthew

AU - Garcia, Santiago

AU - Doing, Anthony H.

AU - Hatem, Raja

AU - Thompson, Craig A.

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S.

PY - 2016/7/20

Y1 - 2016/7/20

N2 - 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.

AB - 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.

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