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Patient Factors Linked to Increased Radiation Exposure During PCI
Researchers of the largest study population to assess radiation exposure to date have found a correlation between clinical and procedural characteristics and higher radiation exposure for patients undergoing PCI and coronary angiography.
Specifically, high body mass index (BMI), a history of CABG, number of lesions treated (≥2) and chronic total occlusions were associated with the highest patient radiation exposure, whereas radial artery access was not linked with increased exposure.
Before the study, the International Commission on Radiological Protection published a paper in 2000 indicating risks of radiation exposure from fluoroscopy-guided procedures, including an increased risk of developing radiation-induced cancers. This along with the increased use of radial access coronary interventions in recent years led study researcher Ronak Delewi, MD, from the University of Amsterdam, and colleagues to determine factors associated with increased radiation exposure during coronary diagnostic and interventional procedures.
Ronak Delewi
The study included all coronary angiography (n=10,819) and PCI (n=9,850) procedures performed at five PCI centers in Western Sweden between Jan. 1, 2008 and Jan. 19, 2012. The researchers collected radiation exposure and clinical data prospectively and made a prediction model to determine radiation exposure (dose-area product).
Multivariable analyses revealed the following characteristics were associated with the highest radiation exposure (P<.001 for all):
- BMI (beta=1.04; CI, 1.04-1.04);
- History of CABG (beta=1.32; CI, 1.28-1.32);
- Two-, three- or four-treated lesions (Two-treated lesions, beta =1.95; CI, 1.84-2.03; Three-treated lesions, beta=2.34; CI, 2.16–2.53; and four-treated lesions, beta=2.83; CI, 2.53–3.16);
- Chronic total occlusion lesions (beta=1.39; CI, 1.31-1.48).
“Although these factors cannot be directly influenced before conducting the coronary angiography or PCI, it is important to know these factors so that patients can be adequately informed,” Delewi and colleagues wrote. “Also, when treating complex or CTO lesions, especially in patients with high BMI or previous CABG, radiation management can be incorporated into pre-procedure planning as well as in defining maximum levels that could guide physicians in decision making during the procedure accordingly.”
After adjusting for procedural complexity, the researchers also found that radial access coronary interventions were not linked with increased radiation exposure (beta=1.00; CI, 0.98-1.03).
Elmir Omerovic
According to Elmir Omerovic, MD, PhD, study investigator from the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, there have been contradictory results reported on radiation exposure when performed by the radial route.
“In this analysis, the radial access route was not associated with increased radiation exposure,” Omerovic told Cardiology Today’s Intervention. “This should encourage more interventionalists to use the radial approach as a standard method for coronary angiography and PCI.”
Disclosure: The researchers report no relevant financial disclosures.