Safety and efficacy of a low frame rate protocol for percutaneous coronary intervention for chronic total occlusions

Fu, Minghuan; Pan, Yuanyuan; Tao, Xue-Fei; Du, Juan; Cheng, Biao

doi:10.1097/cm9.0000000000001395

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…The optimization of fluoroscopic protocols could be considered a new fundamental step to provide a greater reduction in radiation dose without hampering outcomes. In the last few years several studies have been published comparing the effectiveness and safety of low dose fluoroscopic protocols: whilst there is firm evidence for the 7.5 fps fluoroscopic protocols, 6,7 data on 3.75 fps protocols are lacking. Despite the retrospective nature of the study, no difference in the baseline characteristics of the population were found.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of an ultra low dose fluoroscopic protocol for chronic total occlusion recanalization

Bacci

Chiarito

Sánchez

et al. 2023

Cathet Cardio Intervent

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Background: Chronic total occlusion (CTO) revascularization is a major source of radiation for both patients and physicians. Therefore, efforts to minimize radiation during CTO percutaneous coronary intervention (PCI) are highly encouraged. Aims: To evaluate the impact of an Ultra Low fluoroscopic Dose Protocol (ULDP), based on 3.75 frames per second for the fluoroscopy and 7.5 frames per second for the cine acquisition, during CTO PCI. Methods: One hundred fifty consecutive patients who underwent CTO PCI were retrospectively enrolled. Eighty-five underwent standard dose protocol (SDP) and 65 ULDP. Radiation exposure and acute clinical outcomes were compared between groups. Results were stratified according to lesion complexity.Results: Patients undergoing ULDP, as compared to those undergoing SDP, showed a significant reduction of kerma area product, both for simple lesions (6861.0 vs. 13236.0 mGy × cm 2 ; p = 0.014) and complex lesions (CL) (8865.0 vs. 16618.0 mGy × cm 2 ; p < 0.001). Similarly, Air Kerma (AK) was lower when ULDP was used (1222.5 vs. 2015.0 cGy in SL, p = 0.134; 1499.0 vs. 2794.0 cGy in CL, p < 0.001). No significant differences were reported regarding procedural success and in-hospital major adverse cardiovascular events between groups. Notably, there was not any crossover from ULDO to SDP due to poor quality images. Interestingly, fluoroscopy time, procedural time and contrast volume was significantly lower in patients undergoing ULDP only for CLs.Conclusions: ULDP significantly reduces radiation exposure in the setting of high complexity procedures such as CTO PCI. This reduction seemed to be greater with increased procedural complexity and did not impact acute success or adverse clinical events.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of an ultra low dose fluoroscopic protocol for chronic total occlusion recanalization

Bacci

Chiarito

Sánchez

et al. 2023

Cathet Cardio Intervent

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“…[ 1 2 3 ] Multi-vessel coronary artery disease (CAD) occurs in 40–50% of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). [ 4 5 6 ] Previous studies have shown that complete revascularization is associated with lower rates of long-term adverse events when compared with incomplete revascularization. [ 7 , 8 ] However, quite a few CAD patients are unable to achieve complete revascularization because of the adverse characteristics pertinent to the lesions and the systemic background of the patients.…”

Section: Introductionmentioning

confidence: 99%

Residual coronary artery tree description and lesion EvaluaTion (CatLet) score, clinical variables, and their associations with outcome predictions in patients with acute myocardial infarction

Wang

Zhang

et al. 2023

Chinese Medical Journal

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Background: We have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary studies have demonstrated its superiority over the the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score with respect to outcome predictions for acute myocardial infarction (AMI) patients. The current study hypothesized that the residual CatLet (rCatLet) score predicts clinical outcomes for AMI patients and that a combination with the three clinical variables (CVs)—age, creatinine, and ejection fraction, will enhance its predicting values. Methods: The rCatLet score was calculated retrospectively in 308 consecutively enrolled patients with AMI. Primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) including all-cause mortality, non-fatal AMI, transient ischemic attack/stroke, and ischemia-driven repeat revascularization, was stratified according to rCatLet score tertiles: rCatLet_low ≤3, rCatLet_mid 4–11, and rCatLet_top ≥12, respectively. Cross-validation confirmed a reasonably good agreement between the observed and predicted risks. Results: Of 308 patients analyzed, the rates of MACCE, all-cause death, and cardiac death were 20.8%, 18.2%, and 15.3%, respectively. Kaplan–Meier curves for all endpoints showed increasing outcome events with the increasing tertiles of the rCatLet score, with P values <0.001 on trend test. For MACCE, all-cause death, and cardiac death, the area under the curves (AUCs) of the rCatLet score were 0.70 (95% confidence intervals [CI]: 0.63–0.78), 0.69 (95% CI: 0.61–0.77), and 0.71 (95% CI: 0.63–0.79), respectively; the AUCs of the CVs-adjusted rCatLet score models were 0.83 (95% CI: 0.78–0.89), 0.87 (95% CI: 0.82–0.92), and 0.89 (95% CI: 0.84–0.94), respectively. The performance of CVs-adjusted rCatLet score was significantly better than the stand-alone rCatLet score in terms of outcome predictions. Conclusion: The rCatLet score has a predicting value for clinical outcomes for AMI patients and the incorporation of the three CVs into the rCatLet score will enhance its predicting ability. Trial Registration: http://www.chictr.org.cn, ChiCTR-POC-17013536.

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Safety and efficacy of a low frame rate protocol for percutaneous coronary intervention for chronic total occlusions

Cited by 2 publications

References 7 publications

Safety and efficacy of an ultra low dose fluoroscopic protocol for chronic total occlusion recanalization

Safety and efficacy of an ultra low dose fluoroscopic protocol for chronic total occlusion recanalization

Residual coronary artery tree description and lesion EvaluaTion (CatLet) score, clinical variables, and their associations with outcome predictions in patients with acute myocardial infarction

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