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

Authors :
Fazel R
Curtis J
Wang Y
Einstein AJ
Smith-Bindman R
Tsai TT
Chen J
Shah ND
Krumholz HM
Nallamothu BK
Source :
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2013 Dec 01; Vol. 82 (7), pp. 1091-105. Date of Electronic Publication: 2013 Jul 24.
Publication Year :
2013

Abstract

Objectives: Identifying the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI).<br />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.<br />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.<br />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.<br />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.<br /> (Copyright © 2013 Wiley Periodicals, Inc.)

Details

Language :
English
ISSN :
1522-726X
Volume :
82
Issue :
7
Database :
MEDLINE
Journal :
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Publication Type :
Academic Journal
Accession number :
23703793
Full Text :
https://doi.org/10.1002/ccd.24996