An evaluation of fluoroscopy time and correlation with outcomes after percutaneous coronary intervention

We evaluated short-term prognosis and resource utilization of consecutive patients treated with percutaneous coronary intervention (PCI) as a function of fluoroscopy time.

Advances in interventional cardiology are reflected in the growing complexity of PCI leading to an increasing use of fluoroscopic guidance. The relationship between fluoroscopy time and in-hospital outcomes after PCI has not been addressed.

In a retrospective analysis of a prospectively collected database including a total of 9,650 patients, the mean fluoroscopy time was 18.3 +/- 12.2 minutes. Outcomes were stratified by fluoroscopy time.

Compared to patients within the 75th percentile, those with prolonged fluoroscopy time were older and had a higher prevalence of prior coronary artery bypass surgery (CABG), chronic renal insufficiency, peripheral arterial disease, type B2/C lesions, and baseline TIMI flow 0-2. Patients with prolonged fluoroscopy time had higher rates of in-hospital death (3.3% vs. 0.3%; p <0.0001), emergent CABG (2.1% vs. 0.3%; p = 0.0001), stent thrombosis (2.9% vs. 1.3%; p = 0.17), retroperitoneal hematoma (0.9% vs. 0.2%; p = 0.01), and contrast-induced nephropathy (6.7% vs. 4.5%; p = 0.03). Resource utilization was significantly higher (p <0.0001) in patients with prolonged fluoroscopy time. By multivariate analysis, prolonged fluoroscopy time was most strongly associated with prior CABG (OR = 2.39), ostial lesion (OR = 2.87), severe lesion calcification (OR = 2.14), baseline TIMI flow 0-2 (OR = 3.71) (all p <0.0001), lesion eccentricity (OR = 1.96; p = 0.0063), and peripheral arterial disease (OR = 1.91; p = 0.0068).

Prolonged fluoroscopy time is associated with higher complexity of treated lesions and increased rates of periprocedural complications including early mortality, emergent CABG, contrast-induced nephropathy, and increased resource utilization.