Impacto das lesões complexas na exposição radiológica durante intervenção coronária percutânea

Abstract

background: Percutaneous coronary interventions (PCIs) in complex lesions are increasingly common in daily practice. The objective of this study was to determine the impact of complex lesions on radiological exposure during PCI. Methods: Prospective cohort study including patients undergoing PCI between August 2010 and December 2011. Clinical, angiographic and radiation exposure characteristics were recorded in a dedicated database. Patterns of radiation exposure (total dose received, fluoroscopy time and dose-area product) were determined in patients undergoing PCI for non complex (A/B1) and complex (B2/C) lesions. Data were analyzed by the SPSS 18.0 program. Independent radiation exposure predictors were determined by multiple logistic regression. Results: We analyzed 413 PCIs, 83 lesions in group A/B1 and 330 in group B2/C. There were no clinically significant differences between groups. The median radiation dose received by patients was significantly higher in group B2/C (1,103.9 mGy vs 866.6 mGy; P < 0.01). The dose-area product (43,484 mGy.cm² vs 58,327 mGy.cm²; P < 0.001) and fluoroscopy time (9 ± 6 minutes vs 12.1 ± 9.5 minutes; P = 0.001) were also significantly higher in group B2/C. Predictors of increased radiation exposure were weight [odds ratio (OR) 1.02 for each increase of 1 kg, confidence interval (CI) 1.01-1.036; P = 0.004], type B2/C lesion (OR 1.9, CI 1.002-4.96; P = 0.002). Conclusions: Patients undergoing PCI in complex lesions are significantly more exposed to radiation. Weight and lesion type (B2/C) are predictors of increased radiation exposure.

Padrão de Exposição Radiológica em Profissionais da Saúde Durante Procedimentos Cardiológicos Invasivos

“…The authors have previously demonstrated the current patterns of radiological exposure during diagnostic and therapeutic procedures. 1 In addition, they determined that weight, 8 type of procedure, 9,10 and the radial access route 11 are important predictors of increased radiation exposure. However, until recently, individual occupational exposure with the use of flat-panel detector devices was unknown.…”

Riscos da Radiação X e a Importância da Proteção Radiológica na Cardiologia Intervencionista: Uma Revisão Sistemática

“…Na literatura nacional, têm sido pouco relatadas as doses em pacientes da Cardiologia Intervencionista. Pesquisas realizadas no Estado do Rio Grande do Sul 26,27,55 mostraram que o P KA , em procedimentos de Cardiologia Intervencionista, variou entre 41 a 55 Gy.cm 2 e 62 a 103 Gy.cm 2 , para os procedimentos diagnósticos e terapêuticos, respectivamente (valores do terceiro quartil).…”

“…O estudo de Azevedo et al 55 determinou o impacto das lesões complexas na exposição radiológica durante ICP. Foi concluído que a exposição radiológica é significativamente maior nos pacientes submetidos a ICP em lesões complexas do tipo B2/C, comparadas às do tipo A/B1, e que o peso do paciente e o tipo de lesão (B2/C) são preditores de exposição radiológica aumentada.…”