Determinants of Fluoroscopy Time for Invasive Coronary Angiography and Percutaneous Coronary Intervention: Insights from the NCDR®

被引：32

作者：

Fazel, Reza ^{[1
]}

Curtis, Jeptha ^{[2
]}

Wang, Yongfei ^{[2
]}

Einstein, Andrew J. ^{[3
,4
,5
]}

Smith-Bindman, Rebecca ^{[6
,7
,8
]}

Tsai, Thomas T. ^{[9
,10
]}

Chen, Jersey ^{[2
]}

Shah, Nilay D. ^{[11
]}

Krumholz, Harlan M. ^{[2
,12
,13
,14
]}

Nallamothu, Brahmajee K. ^{[15
,16
,17
]}

机构：

[1] Emory Univ, Sch Med, Dept Med, Div Cardiol, Atlanta, GA 30322 USA

[2] Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06510 USA

[3] Columbia Univ, Med Ctr, Dept Med, Div Cardiol, New York, NY USA

[4] Columbia Univ, Med Ctr, Dept Radiol, New York, NY USA

[5] New York Presbyterian Hosp, New York, NY USA

[6] Univ Calif San Francisco, Sch Med, Dept Radiol & Biomed Imaging, San Francisco, CA USA

[7] Univ Calif San Francisco, Sch Med, Dept Epidemiol & Biostat, San Francisco, CA USA

[8] Univ Calif San Francisco, Sch Med, Dept Obstet Gynecol & Reprod Sci, San Francisco, CA USA

[9] Denver Vet Affairs VA Med Ctr, Denver, CO USA

[10] Univ Colorado, Dept Internal Med, Denver, CO 80202 USA

[11] Mayo Clin, Div Hlth Care Policy & Res, Rochester, MN USA

[12] Yale Univ, Sch Med, Dept Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA

[13] Yale Univ, Sch Med, Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT USA

[14] Yale New Haven Hosp, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA

[15] Vet Affairs Ann Arbor Hlth Serv Res, Ann Arbor, MI USA

[16] Dev Ctr Excellence, Ann Arbor, MI USA

[17] Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI 48109 USA

来源：

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS | 2013年 / 82卷 / 07期

关键词：

RDA-radiation physics; CATH-diagnostic cardiac catheterization; PCI-percutaneous coronary intervention; RADIATION PROTECTION; IONIZING-RADIATION; PATIENT; EXPOSURE; PHYSICIAN; AWARENESS; SAFETY; VOLUME;

D O I：

10.1002/ccd.24996

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives: Identifying the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). Background: ICA and PCI are significant contributors to radiation exposure from medical imaging in the US. Fluoroscopy time is a potentially modifiable determinant of radiation exposure for these procedures, but has not been well characterized in contemporary practice. Methods: We evaluated the distribution of fluoroscopy time in patients undergoing ICA and/or PCI in the CathPCI Registry VR, stratifying patients by numerous clinical scenarios. Hierarchical models were used to determine patient, procedure, operator and hospital-level factors associated with fluoroscopy time for these procedures. Results: Our study included a total of 3,295,348 ICA and PCI procedures performed by 9,600 operators from January 2005 through June 2009. There was wide variation in fluoroscopy times for these procedures with median [IQR] fluoroscopy times of 2.6 [1.7-4.5] minutes for ICA, 6.7 [4.2-10.8] minutes for ICA in patients with prior coronary artery bypass grafting (CABG), 10.1 [6.0-17.4] minutes for PCI, 10.7 [7.0-16.9] minutes for PCI with ICA, and 16.0 [10.6-24.0] minutes for PCI and ICA in patients with prior CABG. Prolonged fluoroscopy times (>30 minutes) were rare for ICA, but occurred in 6.7% of PCIs and 14.7% of PCIs in patients with prior CABG. After accounting for patient characteristics and procedure complexity, operator and hospital-level factors explained nearly 20% of the variation in fluoroscopy time. Conclusions: Fluoroscopy times vary widely during ICA and PCI with operator and hospital-level factors contributing substantially to these differences. A better understanding of potentially modifiable sources of this variation will elucidate opportunities for enhancing the radiation safety of these procedures. (C) 2013 Wiley Periodicals, Inc.

引用

页码：1091 / 1105

页数：15

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