Predictors of Excess Patient Radiation Exposure During Chronic Total Occlusion Coronary Intervention: Insights From a Contemporary Multicentre Registry.
High patient radiation dose during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) might lead to procedural failure and radiation skin injury.



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.



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.



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.
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA.
Georgios E
GE
Christakopoulos
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA.
Georgios
G
Christopoulos
Columbia University, New York, New York, USA.
Dimitri
D
Karmpaliotis
Henry Ford Hospital, Detroit, Michigan, USA.
Khaldoon
K
Alaswad
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Robert W
RW
Yeh
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Farouc A
FA
Jaffer
Torrance Memorial Medical Center, Torrance, California, USA.
Michael R
MR
Wyman
University of Washington, Seattle, Washington, USA.
William L
WL
Lombardi
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA.
Muhammad Nauman J
MN
Tarar
Mid America Heart Institute, Kansas City, Missouri, USA.
J Aaron
JA
Grantham
Piedmont Heart Institute, Atlanta, Georgia, USA.
David E
DE
Kandzari
Piedmont Heart Institute, Atlanta, Georgia, USA.
Nicholas
N
Lembo
Columbia University, New York, New York, USA.
Jeffrey W
JW
Moses
Columbia University, New York, New York, USA.
Ajay J
AJ
Kirtane
Columbia University, New York, New York, USA.
Manish
M
Parikh
Columbia University, New York, New York, USA.
Philip
P
Green
Columbia University, New York, New York, USA.
Matthew
M
Finn
Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, Minnesota, USA.
Santiago
S
Garcia
Medical Center of the Rockies, Loveland, Colorado, USA.
Anthony H
AH
Doing
Columbia University, New York, New York, USA.
Raja
R
Hatem
Boston Scientific, Natick, Massachusetts, USA.
Craig A
CA
Thompson
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA.
Subhash
S
Banerjee
VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas, USA; Minneapolis Heart Institute, Minneapolis, Minnesota, USA. Electronic address: esbrilakis@gmail.com.
Emmanouil S
ES
Brilakis
D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography / Q000009:adverse effects*; D054059:Coronary Occlusion / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D000069079:Radiation Exposure / Q000009:adverse effects*; D011832:Radiation Injuries / Q000175:diagnosis* / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology