Key result
A 10-minute increment in fluoroscopy time was associated with increased procedural failure in both non-CTO (OR 1.15; 95% CI 1.12-1.18) and CTO PCI (OR 1.05; 95% CI 1.03-1.06).
Why the study?
The impact of prolonged fluoroscopy time on procedural outcomes in percutaneous coronary interventions is poorly studied.
Does prolonged fluoroscopy time increase the risk of procedural failure in patients undergoing elective PCI for stable coronary artery disease?
Cohort (n=12,538)
Does prolonged fluoroscopy time increase the risk of procedural failure in patients undergoing elective PCI for stable coronary artery disease?
Prolonged fluoroscopy time is strongly associated with procedural failure in both CTO and non-CTO elective PCI, driven by technical failure in CTO and major complications in non-CTO.
Answers are grounded in this paper and cite their sources.
Fluoroscopy time should not yet guide elective PCI decisions; hypothesis-generating for procedural efficiency in stable CAD.
Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, n = 2720) and PCI for non-CTO (n = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both p < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, p < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, p < 0.001) in CTO PCI. The optimal cut-point for prediction of PF was 21.1 min in non-CTO PCI (procedural success in 98.4% versus 95.3%, adjusted OR for PF 2.79 (CI 95% 1.93–4.04), p < 0.001) and 41 min in CTO PCI (procedural success in 92.3% versus 83.8%, adjusted OR for PF 2.18 (CI 95% 1.64–2.94), p < 0.001). In CTO PCI, the increase in PF with FT was largely driven by technical failure (adjusted OR 2.25 (CI 95% 1.65–3.10), p < 0.001), whereas in non-CTO PCI, it was driven by major complications (adjusted OR 2.94 (CI 95% 1.93–4.53), p < 0.001). Conclusions: Prolonged FT is strongly associated with procedural failure in both non-CTO and CTO PCI. In CTO PCI, this relation is shifted towards longer FT. The mechanisms of procedural failure differ between CTO and non-CTO PCI.
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Tajti et al. (2021) conducted a cohort in Stable coronary artery disease with and without chronic total occlusion (n=12,538). Prolonged fluoroscopy time vs. Shorter fluoroscopy time was evaluated on Procedure failure (composite of technical failure, MACCE, and pericardial tamponade) (OR 1.15, 95% CI 1.12-1.18, p=<0.001). A 10-minute increment in fluoroscopy time was associated with increased procedural failure in both non-CTO (OR 1.15; 95% CI 1.12-1.18) and CTO PCI (OR 1.05; 95% CI 1.03-1.06).
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