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This study analyzed 10,634 percutaneous coronary intervention (PCI) procedures to identify factors predicting excessive radiation exposure during these heart procedures. Researchers found that radiation-alert thresholds were exceeded in approximately 1% of all procedures, but five times more frequently (2.1%) during complex PCIs. They developed a predictive risk score using early procedural variables including body mass index, sex, and procedure complexity that could identify high-risk cases with good accuracy before significant radiation dose accumulates.
Why it matters
The radiation-alert risk score could enable clinicians to identify high-risk procedures early and implement dose-reduction strategies proactively, protecting both patients and medical staff from unnecessary radiation exposure. This tool addresses a practical clinical need for planning-stage risk stratification in interventional cardiology.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Ionizing radiation is inherent to percutaneous coronary intervention (PCI) and may reach radiation-alert thresholds during complex procedures. Real-world data translating dose determinants into a usable planning-stage alert tool remain scarce. Aims: To determine the prevalence and predictors of radiation overexposure (RO) during PCI and to develop a pragmatic radiation-alert risk score usable before substantial dose accumulates. Methods: We analysed 10,634 consecutive PCI procedures performed between January 2008 and May 2018. Complex PCI was defined as unprotected left main, rotational atherectomy, chronic total occlusion (CTO), or bifurcation/trifurcation PCI. The composite RO endpoint was a dose-area product >500 Gy{middle dot}cm2, cumulative reference-point air kerma (AK) >5 Gy, or fluoroscopy time >60 minutes. A pragmatic score was built from early procedural variables. Results: Overall, 3,457 procedures (32.5%) were complex, and RO occurred in 99 (0.93%). Complex PCI showed higher RO rates than standard PCI (2.1% vs 0.4%; p<0.001). In multivariable analysis, body mass index (BMI), male sex, CTO, rotational atherectomy, bifurcation, and treatment of [≥]2 vessels independently predicted higher AK. A pragmatic score derived from early clinical and procedural variables showed good discrimination (area under the curve 0.772; 95% bootstrap CI 0.725-0.818) and was well calibrated (Brier score 0.0091; observed-to-expected ratio 0.994) for the composite RO endpoint. Conclusions: Radiation-alert thresholds were exceeded in approximately 1% of PCI procedures, but fivefold more often during complex PCI. A pragmatic, internally assessed score based on early procedural variables identified high-risk cases with good discrimination, supporting planning-stage risk stratification to activate dose-sparing strategies before substantial radiation has accumulated.