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Patient factors linked to increased radiation exposure during percutaneous coronary intervention
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Researchers involved with the largest study to date to assess radiation exposure found a correlation between clinical and procedural characteristics and higher radiation exposure among patients undergoing percutaneous coronary intervention and coronary angiography.
Specifically, high BMI, a history of coronary artery bypass grafting (CABG), number of lesions treated (≥2) and chronic total occlusions were associated with the highest patient radiation exposure. Radial artery access was not linked to increased exposure.
The International Commission on Radiological Protection published a paper in 2000 indicating risks of radiation exposure from fluoroscopy-guided procedures, including an increased risk for developing radiation-induced cancers.
This, along with the increased use of radial access coronary interventions in recent years, led researchers of the current study to determine factors associated with increased radiation exposure during coronary diagnostic and interventional procedures.
The study included all coronary angiography (n=10,819) and percutaneous coronary intervention (n=9,850) procedures performed at five centers in Sweden from 2008 to 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: BMI (beta=1.04); history of CABG (beta=1.32); two or more treated lesions (two treated lesions, beta=1.95; three treated lesions, beta=2.34; and four treated lesions, beta=2.83); and chronic total occlusion lesions (beta=1.39; P<.001 for all).
“Although these factors cannot be directly influenced before conducting the coronary angiography or percutaneous coronary intervention, it is important to know these factors so that patients can be adequately informed,” the researchers wrote. “Also, when treating complex or chronic total occlusion 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 to increased radiation exposure (beta=1.00; P=.67).
Reference:
Delewi R. Circ Cardiovasc Interv. 2013;doi:10.1161/circinterventions.113.000220.