Does Ad Hoc Coronary Intervention Reduce Radiation Exposure? - Analysis of 568 Patients

Abstract

BackgroundAdvantages and disadvantages of ad hoc percutaneous coronary intervention have been described. However little is known about the radiation exposure of that procedure as compared with the staged intervention.ObjectiveTo compare the radiation dose of the ad hoc percutaneous coronary intervention with that of the staged procedureMethodsThe dose-area product and total Kerma were measured, and the doses of the diagnostic and therapeutic procedures were added. In addition, total fluoroscopic time and number of acquisitions were evaluated.ResultsA total of 568 consecutive patients were treated with ad hoc percutaneous coronary intervention (n = 320) or staged percutaneous coronary intervention (n = 248). On admission, the ad hoc group had less hypertension (74.1% vs 81.9%; p = 0.035), dyslipidemia (57.8% vs. 67.7%; p = 0.02) and three-vessel disease (38.8% vs. 50.4%; p = 0.015). The ad hoc group was exposed to significantly lower radiation doses, even after baseline characteristic adjustment between both groups. The ad hoc group was exposed to a total dose-area product of 119.7 ± 70.7 Gycm2, while the staged group, to 139.2 ± 75.3 Gycm2 (p < 0.001).ConclusionAd hoc percutaneous coronary intervention reduced radiation exposure as compared with diagnostic and therapeutic procedures performed at two separate times.

Radiation doses during cardiac catheterisation procedures in India: a multicentre study

“…Ad hoc PCI increased DRL significantly, with mean DAP 56.2±42.7 Gy•cm 2 where as the PCI group had a mean of 40.4±47.1 Gy•cm 2 . In a study published by Truffa et al 20 , the ad hoc group had lower total DAP 119.7±70.7 Gy•cm 2 , compared to the staged group, 139.2±5.3 Gy•cm 2 (p<0.001), but the staged group's total DAP included the radiation during both CAG and PCI, and thus cannot be compared to the present study. Fluoroscopy time, number of cine frames, and image acquisition settings are conventional risk factors of radiation 18 .…”

2018 ESC/EACTS Guidelines on myocardial revascularization

“…Ad hoc PCI is convenient, often cost-effective and safe, and is associated with fewer access site complications and lower radiation exposure. 55,56 However, in the USA, up to 30% of patients undergoing ad hoc PCI are potential candidates for CABG. 56 This number may be lower in Europe.…”