Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR®

Reza Fazel, Jeptha Curtis, Yongfei Wang, Andrew J. Einstein, Rebecca Smith-Bindman, Thomas T. Tsai, Jersey Chen, Nilay D Shah, Harlan M. Krumholz, Brahmajee K. Nallamothu

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

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®, 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.

Original languageEnglish (US)
Pages (from-to)1091-1105
Number of pages15
JournalCatheterization and Cardiovascular Interventions
Volume82
Issue number7
DOIs
StatePublished - Dec 1 2013

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Fluoroscopy
Percutaneous Coronary Intervention
Coronary Angiography
Coronary Artery Bypass
Diagnostic Imaging
Registries
Radiation
Safety

Keywords

  • CATH - diagnostic cardiac catheterization
  • PCI - percutaneous coronary intervention
  • RDA - radiation physics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention : Insights from the NCDR®. / Fazel, Reza; Curtis, Jeptha; Wang, Yongfei; Einstein, Andrew J.; Smith-Bindman, Rebecca; Tsai, Thomas T.; Chen, Jersey; Shah, Nilay D; Krumholz, Harlan M.; Nallamothu, Brahmajee K.

In: Catheterization and Cardiovascular Interventions, Vol. 82, No. 7, 01.12.2013, p. 1091-1105.

Research output: Contribution to journalArticle

Fazel, R, Curtis, J, Wang, Y, Einstein, AJ, Smith-Bindman, R, Tsai, TT, Chen, J, Shah, ND, Krumholz, HM & Nallamothu, BK 2013, 'Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention: Insights from the NCDR®', Catheterization and Cardiovascular Interventions, vol. 82, no. 7, pp. 1091-1105. https://doi.org/10.1002/ccd.24996
Fazel, Reza ; Curtis, Jeptha ; Wang, Yongfei ; Einstein, Andrew J. ; Smith-Bindman, Rebecca ; Tsai, Thomas T. ; Chen, Jersey ; Shah, Nilay D ; Krumholz, Harlan M. ; Nallamothu, Brahmajee K. / Determinants of fluoroscopy time for invasive coronary angiography and percutaneous coronary intervention : Insights from the NCDR®. In: Catheterization and Cardiovascular Interventions. 2013 ; Vol. 82, No. 7. pp. 1091-1105.
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abstract = "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{\circledR}, 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.",
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T2 - Insights from the NCDR®

AU - Fazel, Reza

AU - Curtis, Jeptha

AU - Wang, Yongfei

AU - Einstein, Andrew J.

AU - Smith-Bindman, Rebecca

AU - Tsai, Thomas T.

AU - Chen, Jersey

AU - Shah, Nilay D

AU - Krumholz, Harlan M.

AU - Nallamothu, Brahmajee K.

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N2 - 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®, 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.

AB - 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®, 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.

KW - CATH - diagnostic cardiac catheterization

KW - PCI - percutaneous coronary intervention

KW - RDA - radiation physics

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