Predictors of increased radiation dose during percutaneous coronary intervention

Radiation-induced injury is a potential unintended outcome of fluoroscopy-supported cardiology procedures (e.g., percutaneous coronary intervention [PCI]). The injury might be deterministic in nature. Air kerma (AK) is considered an indicator of skin dose, and thus, an indicator for deterministic effects. Few studies have investigated the factors that contribute to an increased radiation dose, and none have used AK as a dependent variable. We studied the registry data of 967 consecutive patients (derivation model) undergoing ad hoc PCI. Linear and multiple regression analyses were performed to investigate which clinical, technical, and anatomic factors were associated with an increased AK. Multiple regression analyses were performed on an additional sample of 1,082 consecutive patients (validation model) to confirm the results. The variables found significant (multiple regression analyses) were radial access (mean increase in AK 253 mGy, 95% confidence interval [CI] 104 to 418, p = 0.0006), number of lesions treated (547 mGy, 95% CI 332 to 789, p < 0.0001), Type C lesions (132 mGy, 95% CI, 26 to 246, p = 0.014), bifurcation lesions (280 mGy, 95% CI 104 to 477, p = 0.0013), and chronic total occlusions (453 mGy, 95% CI 76 to 923, p = 0.016). The validation model (n = 1,082) confirmed all but type C lesions (p = 0.065). In conclusion, the present study has described factors that might contribute to an increased AK during PCI. In revealing a priori known factors associated with an increased radiation dose during PCI, physicians and patients might be more able to evaluate the risks and benefits of such a procedure.