Author + information
- Davide Maccagni1,
- Susanna Benincasa2,
- Barbara Bellini2,
- Luciano Candilio1,
- Enrico Poletti1,
- Mauro Carlino2,
- Antonio Colombo3 and
- Lorenzo Azzalini4
Chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is associated with high radiation exposure for both patients and operators. Our study aim was to evaluate the impact of the implementation of a noise reduction technology (NRT) on patient radiation exposure during CTO PCI.
A total of 187 CTO PCIs performed between February 2016 and May 2017 was analyzed according to two angiographic systems, Standard and NRT. Propensity score matching (PSM) was performed to control for differences in baseline clinical and angiographic characteristics. Standard group and NRT group were matched (1:1 ratio) by age, sex, body mass index, contrast volume, fluoroscopy time, number of cine acquisitions, use of 7.5 frames-per-second setting, and Japanese-CTO (J-CTO) score. The study primary endpoints were Cumulative Air Kerma at Interventional Reference Point (AK at IRP), which correlates with patient’s tissue reactions, and Kerma Area Product (KAP), a surrogate measure of patient’s risk of stochastic radiation effects. Study secondary endpoint was if the procedure exceeded one of the trigger level points for a potential skin injury (KAP of 500 Gycm2 and/or AK at IRP of 5 Gy).
After PSM, n=56 pairs were identified. Baseline and angiographic characteristics between the two groups were well matched. Compared to the Standard protocol, NRT was associated with lower AK at IRP [2.514 (1.804-3.660) vs. 3.257 (2.089-5.343) Gy, p=0.025] and a strong trend towards reduction for KAP [167 (127.25-243) vs. 203 (140.25-359.75) Gycm2, p=0.053]. No difference between groups was found with regards to KAP trigger level dose. However, the Standard group had a higher incidence of exceeding AK at IRP trigger level dose, compared with NRT [n=15 (26.8%) vs n=5 (8.9%), p=0.014].
The use of NRT in CTO PCI is associated with markedly lower patient radiation exposure, compared with a Standard protocol.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)