Radiation exposure during percutaneous coronary intervention (PCI) has fallen “considerably” during the last decade, but variability between cath labs underlines the need for further radiation dose reduction.
This is the conclusion of research authored by Thomas J Stocker (Ludwig-Maximilians-Universität, Munich, Germany), published online this week in the journal EuroIntervention. Stocker and colleagues’ study—PROTECTION VIII—was designed to assess the PCI-related radiation dose over the last decade and to identify predictors of increased dose exposure.
PROTECTION VIII included all PCIs reported to a German quality assurance programme between 2008 and 2018. Within the study, dose area product (DAP) and radiation time were analysed, effective dose (ED) was estimated (ED=DAP*k; conversion coefficient k=0.0022 mSv/cGy*cm2), and multivariate linear regression analysis was used to identify predictors associated with a clinically relevant increase of radiation dose (ED ≥1 mSv).
A total of 3,704,986 patients undergoing PCI (median age 70 years, 30% female) were studied, with indications including chronic coronary syndrome (37.5%), unstable angina pectoris and non-ST-segment elevation myocardial infarction (non-STEMI; 33.2%) and STEMI (18.5%).
The researchers reported a median DAP of 4,203 (interquartile range [IQR] 2,313-7,300) cGy*cm, ED was 9.2 mSv and median radiation time was 9.2 (IQR 5.8-15) min.
Within the 10-year period, radiation exposure was reduced by 36% (p<0.001) and resulted in a median DAP of 3,070 cGy*cm (ED 6.8 mSv) in 2018, Stocker and colleagues report. However, they also note a significant 5.3-fold variability of median DAP was observed between catheterisation laboratories (p<0.001).
“This radiation dose survey demonstrates a considerable reduction of PCI radiation exposure during the last decade,” Stocker et al write in their conclusion. “However, large variability between catheterisation laboratories underlines the need for further radiation dose reduction.”