Decline in radiation during CTO PCI could reflect improvements in X-ray systems
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Radiation dose during chronic total occlusion PCI decreased between 2012 and 2020 and may be attributed to the use of newer X-ray systems, according to a research letter published in Circulation: Cardiovascular Interventions.
For this analysis, investigators evaluated trends and risk factors for elevated radiation dose in 6,305 patients who were enrolled in the PROGRESS-CTO registry between 2012 and 2020 (mean age, 65 years; 82% men; 42% with diabetes; 31% with prior CABG).
Although skin injury linked to radiation dose is infrequent, according to the letter, no injury was reported in this cohort of patients who underwent CTO PCI.
In this cohort, the median air kerma radiation dose was 2.3 Gy (interquartile range, 1.3-3.9 ).
Researchers observed that median radiation dose decreased over time (P < .0001), was variable by X-ray systems (P < .0001) and the use of newer systems (Allura Clarity, Philips; Q-zen, Siemens) increased between 2012 and 2020.
In addition, use of IVUS was associated with lower median air kerma dose (2.1 Gy vs. 2.4 Gy; P < .0001).
“Radiation dose administered during CTO PCI has been decreasing over time in this multicenter, international registry,” Evangelia Vemmou, MD, cardiology research fellow at the Minneapolis Heart Institute Foundation, and colleagues wrote. “Potential explanations include increased use of newer X-ray systems, improvements in equipment and techniques, increased use of intravascular imaging and increasing operator expertise.”
In other findings, patients who received a radiation dose greater than 3.235 Gy, the highest tertile of this analysis, had higher median BMI (32 kg/m2 vs. 30 kg/m2 vs. 28 kg/m2; P < .0001), were more likely to have prior CABG (40% vs. 34% vs. 24%; P < .0001) and had higher J Multicenter CTO Registry of Japan and PROGRESS-CTO scores compared with those in the lower radiation tertiles (P < .0001).
“Our study has limitations,” the researchers wrote. “First, it is an observational, retrospective study. Second, there was no clinical event adjudication by a clinical events committee. Third, all procedures were performed at high-volume, experienced PCI centers, thus limiting the generalizability of our findings to less experienced centers.”
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