OR05-2
Radiation Exposure and Patient Outcomes in IVUS-Guided Near-Zero Contrast PCI versus IVUS-Guided Ultra-Low Contrast PCI
Christopher Garnett, MD, NewYork-Presbyterian Columbia University Irving Medical Center, East Norwich, NY
Christopher Garnett, MD1, Richard Sekerak2, Khady Fall3, Margaret McEntegart, M.D.2, Jeffrey W. Moses, MD, FSCAI2, Martin B. Leon, M.D.2, Ajay J. Kirtane, M.D., FSCAI2 and Megha Prasad, M.D.4, (1)NewYork-Presbyterian Columbia University Irving Medical Center, East Norwich, NY, (2)NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (3)NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (4)NewYork-Presbyterian Columbia University Irving Medical Center, new york city, NY
Keywords: Complex and High-risk Coronary Intervention (CHIP), Coronary, Quality and Radiation Safety
Background
IVUS-guided ultralow-contrast (ULC) PCI is increasingly becoming more common given the rising prevalence of CKD patients requiring coronary intervention. However, there is sparse published data regarding fluoroscopy time and radiation dose during ULC PCI. Because increased radiation exposure and prolonged fluoroscopy time are associated with early mortality and site complications, we aimed to provide procedural data to better elucidate technical success and safety in these complex procedures with high-risk patients. Methods
We performed a retrospective analysis of patients receiving IVUS-guided ULC PCI (<30 mL) at NYP-Columbia from 2016-2022. Inclusion criteria included patients with CKD stages 3b-5 (eGFR <45 mL/min/1.73m2), not on RRT. The patients were grouped into near-zero contrast PCI group with <10 ml use (NZC) and ultralow-contrast PCI group (ULC) with 10 to < 30 ml contrast utilized. Primary procedural outcomes included the number of vessels intervened on, fluoroscopy time, total radiation dose, access site complication, and MACE at 1 year. Results
100 patients were included: 60 in NZC and 40 in ULC. The mean contrast load was 2.75 mL in the NZC group and 18.4 mL in the ULC group (p=0.01). The total number of coronary vessels intervened on for NZC group (1.85) was not significantly different than the ULC group (1.73), p=0.52. The fluoroscopy time for the NZC group was significantly lower compared to the ULC group (24.1min vs 30.9min, p=0.03) with concomitant significantly lower total radiation dose (939.3 mGy versus 1386.2 mGy, p=0.01). In the NZC group, 6% of patients had access site complications versus 9% in the ULC group (p=0.56). At one year, rates of MACE were 30.0% in the NZC group vs 22.5% in the ULC PCI group (p=0.41). The rate of in-stent restenosis was 7% in the NZC group versus 3% in the ULC group (p=0.35).
Conclusions
NZC PCI, as compared to ULC PCI, had a statistically significant reduction in fluoroscopy time, and radiation dose when intervening on a similar number of vessels. Given similar rates of MACE and in-stent restenosis with a lower total contrast volume and radiation dose, NZC PCI potentially offers an equally safe and radiation-sparing procedure compared to ULC PCI for high-risk patients.