An evaluation of fluoroscopy time and correlation with outcomes after percutaneous coronary intervention.
OBJECTIVE
We evaluated short-term prognosis and resource utilization of consecutive patients treated with percutaneous coronary intervention (PCI) as a function of fluoroscopy time.


BACKGROUND
Advances in interventional cardiology are reflected in the growing complexity of PCI leading to an increasing use of fluoroscopic guidance. The relationship between fluoroscopy time and in-hospital outcomes after PCI has not been addressed.


METHODS
In a retrospective analysis of a prospectively collected database including a total of 9,650 patients, the mean fluoroscopy time was 18.3 +/- 12.2 minutes. Outcomes were stratified by fluoroscopy time.


RESULTS
Compared to patients within the 75th percentile, those with prolonged fluoroscopy time were older and had a higher prevalence of prior coronary artery bypass surgery (CABG), chronic renal insufficiency, peripheral arterial disease, type B2/C lesions, and baseline TIMI flow 0-2. Patients with prolonged fluoroscopy time had higher rates of in-hospital death (3.3% vs. 0.3%; p <0.0001), emergent CABG (2.1% vs. 0.3%; p = 0.0001), stent thrombosis (2.9% vs. 1.3%; p = 0.17), retroperitoneal hematoma (0.9% vs. 0.2%; p = 0.01), and contrast-induced nephropathy (6.7% vs. 4.5%; p = 0.03). Resource utilization was significantly higher (p <0.0001) in patients with prolonged fluoroscopy time. By multivariate analysis, prolonged fluoroscopy time was most strongly associated with prior CABG (OR = 2.39), ostial lesion (OR = 2.87), severe lesion calcification (OR = 2.14), baseline TIMI flow 0-2 (OR = 3.71) (all p <0.0001), lesion eccentricity (OR = 1.96; p = 0.0063), and peripheral arterial disease (OR = 1.91; p = 0.0068).


CONCLUSIONS
Prolonged fluoroscopy time is associated with higher complexity of treated lesions and increased rates of periprocedural complications including early mortality, emergent CABG, contrast-induced nephropathy, and increased resource utilization.
Nikolsky
Eugenia
E
Columbia University Medical Center and the Cardiovascular Research Foundation, New York City, NY 10022, USA.
Pucelikova
Tereza
T
Mehran
Roxana
R
Balter
Stephen
S
Kaufman
Liz
L
Fahy
Martin
M
Lansky
Alexandra J
AJ
Leon
Martin B
MB
Moses
Jeffrey W
JW
Stone
Gregg W
GW
Dangas
George
G
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome