Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization

Insights from a multicenter United States registry

Tesfaldet T. Michael, Dimitri Karmpaliotis, Emmanouil S. Brilakis, Mohammed Alomar, Shuaib M. Abdullah, Ben L. Kirkland, Katrina L. Mishoe, Nicholas Lembo, Anna Kalynych, Harold Carlson, Subhash Banerjee, Michael Luna, William Lombardi, David E. Kandzari

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study. Methods: We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at three US institutions between January 2006 and November 2011. Results: Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had prior coronary artery bypass graft surgery, and 42% had prior PCI. The CTO target vessel was the right coronary artery (55%), circumflex (23%), left anterior descending artery (21%), and left main or bypass graft (1%). The retrograde approach was used in 34% of all procedures. The technical and procedural success rates were 85.5 and 84.2%, respectively. The mean procedural time, fluoroscopy time, and contrast utilization were 113 ± 61 min, 42 ± 29 min, and 294 ± 158 mL, respectively. Years since initiation of CTO PCI were independently associated with higher technical success rate (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.52-1.70, P < 0.001), lower fluoroscopy time (OR = 0.84, 95% CI = 0.75-0.95, P = 0.005), and contrast utilization (OR = 0.84, 95% CI = 0.62-0.79, P < 0.001) during the study period. Conclusions: Among selected US-based institutions performing CTO PCI, we observed a significant reduction in total fluoroscopy time and contrast utilization paralleled with an improved technical success rate over time.

Original languageEnglish (US)
Pages (from-to)393-399
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number3
DOIs
StatePublished - Feb 1 2015

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Fluoroscopy
Registries
Percutaneous Coronary Intervention
Odds Ratio
Confidence Intervals
Transplants
Coronary Artery Bypass
Coronary Vessels
Arteries

Keywords

  • Chronic total occlusion
  • Contrast volume
  • Fluoroscopy
  • Percutaneous coronary intervention
  • Temporal trends

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization : Insights from a multicenter United States registry. / Michael, Tesfaldet T.; Karmpaliotis, Dimitri; Brilakis, Emmanouil S.; Alomar, Mohammed; Abdullah, Shuaib M.; Kirkland, Ben L.; Mishoe, Katrina L.; Lembo, Nicholas; Kalynych, Anna; Carlson, Harold; Banerjee, Subhash; Luna, Michael; Lombardi, William; Kandzari, David E.

In: Catheterization and Cardiovascular Interventions, Vol. 85, No. 3, 01.02.2015, p. 393-399.

Research output: Contribution to journalArticle

Michael, Tesfaldet T. ; Karmpaliotis, Dimitri ; Brilakis, Emmanouil S. ; Alomar, Mohammed ; Abdullah, Shuaib M. ; Kirkland, Ben L. ; Mishoe, Katrina L. ; Lembo, Nicholas ; Kalynych, Anna ; Carlson, Harold ; Banerjee, Subhash ; Luna, Michael ; Lombardi, William ; Kandzari, David E. / Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization : Insights from a multicenter United States registry. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 85, No. 3. pp. 393-399.
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abstract = "Background: The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study. Methods: We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at three US institutions between January 2006 and November 2011. Results: Mean age was 65 ± 11 years, 85{\%} of patients were men, 40{\%} had diabetes, 37{\%} had prior coronary artery bypass graft surgery, and 42{\%} had prior PCI. The CTO target vessel was the right coronary artery (55{\%}), circumflex (23{\%}), left anterior descending artery (21{\%}), and left main or bypass graft (1{\%}). The retrograde approach was used in 34{\%} of all procedures. The technical and procedural success rates were 85.5 and 84.2{\%}, respectively. The mean procedural time, fluoroscopy time, and contrast utilization were 113 ± 61 min, 42 ± 29 min, and 294 ± 158 mL, respectively. Years since initiation of CTO PCI were independently associated with higher technical success rate (odds ratio [OR] = 1.52, 95{\%} confidence interval [CI] = 1.52-1.70, P < 0.001), lower fluoroscopy time (OR = 0.84, 95{\%} CI = 0.75-0.95, P = 0.005), and contrast utilization (OR = 0.84, 95{\%} CI = 0.62-0.79, P < 0.001) during the study period. Conclusions: Among selected US-based institutions performing CTO PCI, we observed a significant reduction in total fluoroscopy time and contrast utilization paralleled with an improved technical success rate over time.",
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T1 - Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization

T2 - Insights from a multicenter United States registry

AU - Michael, Tesfaldet T.

AU - Karmpaliotis, Dimitri

AU - Brilakis, Emmanouil S.

AU - Alomar, Mohammed

AU - Abdullah, Shuaib M.

AU - Kirkland, Ben L.

AU - Mishoe, Katrina L.

AU - Lembo, Nicholas

AU - Kalynych, Anna

AU - Carlson, Harold

AU - Banerjee, Subhash

AU - Luna, Michael

AU - Lombardi, William

AU - Kandzari, David E.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background: The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study. Methods: We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at three US institutions between January 2006 and November 2011. Results: Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had prior coronary artery bypass graft surgery, and 42% had prior PCI. The CTO target vessel was the right coronary artery (55%), circumflex (23%), left anterior descending artery (21%), and left main or bypass graft (1%). The retrograde approach was used in 34% of all procedures. The technical and procedural success rates were 85.5 and 84.2%, respectively. The mean procedural time, fluoroscopy time, and contrast utilization were 113 ± 61 min, 42 ± 29 min, and 294 ± 158 mL, respectively. Years since initiation of CTO PCI were independently associated with higher technical success rate (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.52-1.70, P < 0.001), lower fluoroscopy time (OR = 0.84, 95% CI = 0.75-0.95, P = 0.005), and contrast utilization (OR = 0.84, 95% CI = 0.62-0.79, P < 0.001) during the study period. Conclusions: Among selected US-based institutions performing CTO PCI, we observed a significant reduction in total fluoroscopy time and contrast utilization paralleled with an improved technical success rate over time.

AB - Background: The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study. Methods: We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at three US institutions between January 2006 and November 2011. Results: Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had prior coronary artery bypass graft surgery, and 42% had prior PCI. The CTO target vessel was the right coronary artery (55%), circumflex (23%), left anterior descending artery (21%), and left main or bypass graft (1%). The retrograde approach was used in 34% of all procedures. The technical and procedural success rates were 85.5 and 84.2%, respectively. The mean procedural time, fluoroscopy time, and contrast utilization were 113 ± 61 min, 42 ± 29 min, and 294 ± 158 mL, respectively. Years since initiation of CTO PCI were independently associated with higher technical success rate (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.52-1.70, P < 0.001), lower fluoroscopy time (OR = 0.84, 95% CI = 0.75-0.95, P = 0.005), and contrast utilization (OR = 0.84, 95% CI = 0.62-0.79, P < 0.001) during the study period. Conclusions: Among selected US-based institutions performing CTO PCI, we observed a significant reduction in total fluoroscopy time and contrast utilization paralleled with an improved technical success rate over time.

KW - Chronic total occlusion

KW - Contrast volume

KW - Fluoroscopy

KW - Percutaneous coronary intervention

KW - Temporal trends

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