title: Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization: insights from a multicenter United States registry.
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.
authors.affiliation: Division of Cardiovascular Diseases, Oregon University Health & Science University, Portland, Oregon.
authors.forename: Tesfaldet T
authors.initials: TT
authors.lastname: Michael
authors.forename: Dimitri
authors.initials: D
authors.lastname: Karmpaliotis
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alomar
authors.forename: Shuaib M
authors.initials: SM
authors.lastname: Abdullah
authors.forename: Ben L
authors.initials: BL
authors.lastname: Kirkland
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Mishoe
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lembo
authors.forename: Anna
authors.initials: A
authors.lastname: Kalynych
authors.forename: Harold
authors.initials: H
authors.lastname: Carlson
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Michael
authors.initials: M
authors.lastname: Luna
authors.forename: William
authors.initials: W
authors.lastname: Lombardi
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects / Q000639:trends*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000009:adverse effects / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D003287:Contrast Media
keywords: chronic total occlusion; contrast volume; fluoroscopy; percutaneous coronary intervention; temporal trends