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Catheter Cardiovasc Interv. 2013 Dec 1;82(7):1091-105. doi: 10.1002/ccd.24996. Epub 2013 Jul 24.

Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: insights from the NCDR(®).

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1
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Abstract

OBJECTIVES:

Identifying the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI).

BACKGROUND:

ICA and PCI are significant contributors to radiation exposure from medical imaging in the US. Fluoroscopy time is a potentially modifiable determinant of radiation exposure for these procedures, but has not been well characterized in contemporary practice.

METHODS:

We evaluated the distribution of fluoroscopy time in patients undergoing ICA and/or PCI in the CathPCI Registry(®) , stratifying patients by numerous clinical scenarios. Hierarchical models were used to determine patient, procedure, operator and hospital-level factors associated with fluoroscopy time for these procedures.

RESULTS:

Our study included a total of 3,295,348 ICA and PCI procedures performed by 9,600 operators from January 2005 through June 2009. There was wide variation in fluoroscopy times for these procedures with median [IQR] fluoroscopy times of 2.6 [1.7-4.5] minutes for ICA, 6.7 [4.2-10.8] minutes for ICA in patients with prior coronary artery bypass grafting (CABG), 10.1 [6.0-17.4] minutes for PCI, 10.7 [7.0-16.9] minutes for PCI with ICA, and 16.0 [10.6-24.0] minutes for PCI and ICA in patients with prior CABG. Prolonged fluoroscopy times (>30 minutes) were rare for ICA, but occurred in 6.7% of PCIs and 14.7% of PCIs in patients with prior CABG. After accounting for patient characteristics and procedure complexity, operator and hospital-level factors explained nearly 20% of the variation in fluoroscopy time.

CONCLUSIONS:

Fluoroscopy times vary widely during ICA and PCI with operator and hospital-level factors contributing substantially to these differences. A better understanding of potentially modifiable sources of this variation will elucidate opportunities for enhancing the radiation safety of these procedures.

KEYWORDS:

CATH-diagnostic cardiac catheterization; PCI-percutaneous coronary intervention; RDA-radiation physics

Comment in

PMID:
23703793
DOI:
10.1002/ccd.24996
[Indexed for MEDLINE]
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