Procedural Factors Associated With High Radiation Exposure During Percutaneous Coronary Intervention

An air kerma (AK) radiation dose of 5 Gy is considered a threshold that may result in clinically significant radiation injury during percutaneous coronary intervention (PCI). This study aimed to identify procedural characteristics associated with patient AK ≥ 5 Gy during PCI.

This retrospective study included consecutive PCI procedures performed at West China Hospital between July 30, 2018, and October 31, 2021. Descriptive analysis was conducted to explore associations between baseline characteristics and high radiation doses. Multivariate logistic regression was used to identify procedural predictors of AK ≥ 5 Gy, and a receiver operating characteristic (ROC) curve was applied to assess the model's predictive performance.

A total of 8444 PCI procedures were analyzed. Multivariate logistic regression identified the following procedural predictors of AK ≥ 5 Gy: number of stents implanted (odds ratio [OR]: 1.67; 95% CI: 1.50-1.87), PCI involving left circumflex coronary artery (OR: 1.58; 95% CI: 1.18-2.10), use of intra-aortic ballon pump (OR: 1.91; 95% CI: 1.18-2.99), use of intravascular ultrasound (OR: 1.67; 95% CI: 1.31-2.14), PCI of in-stent restenosis (OR: 2.14; 95% CI: 1.36-3.28), and PCI of chronic total occlusion (OR: 3.40; 95% CI: 2.72-4.24). The area under the ROC curve for the logistic regression model was 0.795, with a specificity of 78.3% and a sensitivity of 67.4%.

Specific procedural characteristics are associated with AK ≥ 5 Gy during PCI. Identifying these risk factors may help optimize radiation safety strategies and minimize patient exposure.