Author + information
- Kamal H. Sharma, MD, DNB,
- Sharad R. Jain, MD, DM,
- Gaurav D. Gandhi, MD, DM∗ ( and )
- Sanjay Vaghani, MD, DM
- ↵∗U.N. Mehta Institute of Cardiology and Research Centre, B-303, Krupal Apartment, Near Subhash Bridge Circle, Sabarmati, Ahmedabad, 380027, Gujarat, India
Conventionally, a combination of both fluoroscopy (FS) and cineangiography (CA) are used during percutaneous coronary intervention (PCI). CA involves higher radiation dosage exposure than regular FS (1). However, FS-guided PCI has not been studied in terms of safety and effectiveness in the past in a randomized, controlled fashion versus conventional CA-guided PCI.
We compared the procedural feasibility, safety, radiation exposure, and short-term clinical outcomes using FS alone with conventional FS- and CA-guided PCI. This was a prospective, randomized controlled trial. Between February 2013 and August 2013, 197 patients with 227 lesions underwent PCI. Patients were randomized in a 1:1 ratio to a protocol of either exclusive FS-guided PCI or combined use of FS and CA guidance.
FS-guided intervention entailed significantly lower radiation exposure compared with CA guidance, both in terms of air kinetic energy released per unit mass (785.19 vs. 2,190.87) and dose–area product (5,798.46 vs. 9,165.24). Procedure time trended toward a lower time required for PCI in the FS group (36.7 min) compared with the CA group (41.75 min), whereas FS time was significantly lower in the FS group (6:52 min) than in the CA group (7:58 min). (Table 1)
There were no significant differences in the incidences of immediate procedural success, peri-procedural myocardial infarction, and procedural death. Major adverse cardiac events (MACEs) at 6 months were also similar in both arms. The mean follow-up period was 6 months. The MACE rates were 2% and 3% in the FS and CA groups, respectively (p = NS). There was no difference in reported adverse events.
In conclusion, compared with conventional CA guidance, FS alone was found to be an equally safe and effective protocol, with similar immediate procedural and 6-month MACE rates, as well as similar clinical outcomes for PCI, and had a significantly lower radiation at the source.
- 2015 American College of Cardiology Foundation