Determinants of high peak radiation skin dose in primary percutaneous coronary interventions

Primary percutaneous coronary intervention (PCI) has improved the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, radiation skin damage is one of serious complications in primary PCI. The purpose of this study was to identify the determinants of the excess radiation dose in primary PCI.

We included 1126 patients with STEMI and divided them into an excess radiation group (n = 61; peak skin dose ≥2 Gy) and a standard radiation group (n = 1065; peak skin dose <2 Gy). Univariate and multivariate logistic regression analyses were performed to find patient or procedural factors associated with excess radiation.

In patient factors, body mass index (BMI) was significantly associated with excess radiation [odds ratio (OR) 1.09, 95 % confidence interval (CI) 1.01-1.18, P = 0.022] after controlling for confounding factors. In procedural factors, use of intra-aortic balloon pumping (OR 2.12, 95 % CI 1.05-4.27, P = 0.035), number of used guidewire (OR 1.70, 95 % CI 1.26-2.31, P < 0.001), number of used balloon (OR 1.50, 95 % CI 1.18-1.92, P = 0.001), total length of stents (OR 1.25, 95 % CI 1.09-1.44, P = 0.002), use of microcatheters (OR 2.18, 95 % CI 1.13-4.21, P = 0.02) and thrombus aspiration (OR 3.86, 95 % CI 2.07-7.20, P < 0.001) were significantly associated with excess radiation after controlling for confounding factors.

In primary PCI for STEMI, high BMI and using many devices were significantly associated with excess radiation. We should pay special attention to patients with high BMI and complex lesions which require many devices to prevent excess skin radiation.