Coronary disease & ACSCohort study
Improvement of Radiation Management in Percutaneous Interventions of Chronic Total Occlusions in a Multicenter Registry
- Registry study
- multicentre
Authors' conclusion
AK for CTO PCI was reduced during the past decade to a level such that most procedures no longer must be aborted because of excess radiation. Equipment updates were instrumental, but interoperator differences remained.
Study context
- Population
- CTO percutaneous coronary intervention (PCI) procedures by 14 operators continuously participating in the European Registry of CTO-PCI, 2012–2023
- Participants
- 16,439 procedures
- Exposure
- Radiation dose in CTO PCI over time, 2012 to 2023
- Outcome
- Changes in air kerma (AK) and dose rate index (DRI = AK per fluoroscopy time) and their determinants
Main finding
As reported in the abstract
Air kerma (AK) · 2012 to 2023
Air kerma (AK) decreased from 2.50 Gy (Q1-Q3: 1.54-4.04 Gy) to 1.20 Gy (Q1-Q3: 0.66-2.12 Gy)
reduction of 52.0% (P < 0.001)
Dose rate index (DRI) after equipment update 31.5 mGy/min (Q1-Q3: 22.0-45.6 mGy/min)
decrease of 28.0% (P < 0.001)
Observational data: associations, not effects.
Further findings
Lesion complexity (median J-CTO score)
- Increased from 2 (Q1-Q3: 1-3) to 3 (Q1-Q3: 2-3)
- P < 0.001
Technical success
- Improved from 89.1% to 94.9%, with stable fluoroscopy time
- P < 0.001
Determinants of excess radiation
- Clinical: BMI, gender, previous bypass surgery; procedural: Fluoroscopy time (FT), retrograde approach, IVUS use; equipment: radiographic equipment updates, fluoroscopy dose mode
- Considerable interoperator variability in DRI
Original publication
Improvement of Radiation Management in Percutaneous Interventions of Chronic Total Occlusions in a Multicenter Registry. JACC Cardiovasc Interv. Published 24 February 2025. doi:10.1016/j.jcin.2024.11.009
Summarised from the published abstract; every number is checked against it