Radiation dose during CTO-PCI: Insights from the PROGRESS-CTO registry

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Conference Proceeding

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Catheter Cardiovasc Interventions


Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be associated with increased risk of excessive radiation.

Methods: We examined radiation dose in 5,635 patients undergoing CTO-PCI at 28 US and international centers between 2012 and 2019. We compared the group of patients that had fluoroscopy air kerma (AK) radiation dose above the median (>2.4 Gy) and those who had AK radiation dose below the median (≤2.4 Gy).

Results: Mean age was 64.5 ±10 years and 83% of patients were men. Median AK radiation dose was 2.4 [1.3-4.1] Gy. The proportion of procedures that had AK dose >2.4 Gy decreased over time (Figure, Panel A). Median AK radiation dose was significantly lower in 2019 vs. 2012 (1.9 [1.1, 3.2] vs. 4.4 [2.5, 6.2] Gray, p<0.0001) (Figure, Panel B). Median body mass index was higher in the higher radiation group (31.4 [27.9, 35.8] vs 28.4 [25.5, 32.3], p<0.0001). Patients in the higher radiation dose group were more likely to have previous coronary artery bypass graft surgery compared with patients in the lower radiation group (41% vs. 28%, p<0.0001). Median J-CTO score (3 [2,4] vs. 2 [1, 3], p<0.0001) and median procedure time (167 [119,223] vs. 104 [72,143] min, p<0.0001) were higher in the higher radiation group. Technical and procedural success were lower in the higher radiation group (84% vs. 91%, 82% vs. 90%, respectively, p<0.0001) and the incidence of in-hospital major adverse cardiovascular events was higher (3.3% vs. 1.7%, p=0.0025). There was no reported radiation skin injury.

Conclusions: AK radiation dose during CTO-PCI has significantly decreased in recent years among high-volume, experienced centers.



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