An evaluation of fluoroscopy time and correlation with outcomes after percutaneous coronary intervention

OBJECTIVE: We evaluated short-term prognosis and resource utilization of consecutive patients treated with percutaneous coronary intervention (PCI) as a function of fluoroscopy time. BACKGROUND: Advances in interventional cardiology are reflected in the growing complexity of PCI leading to an increasing use of fluoroscopic guidance. The relationship between fluoroscopy time and in-hospital outcomes after PCI has not been addressed. METHODS: In a retrospective analysis of a prospectively collected database including a total of 9,650 patients, the mean fluoroscopy time was 18.3 ± 12.2 minutes. Outcomes were stratified by fluoroscopy time. RESULTS: Compared to patients within the 75th percentile, those with prolonged fluoroscopy time were older and had a higher prevalence of prior coronary artery bypass surgery (CABG), chronic renal insufficiency, peripheral arterial disease, type B2/C lesions, and baseline TIMI flow 0 - 2. Patients with prolonged fluoroscopy time had higher rates of in-hospital death (3.3% vs. 0.3%; p <0.0001), emergent CABG (2.1% vs. 0.3%; p ≤ 0.0001), stent thrombosis (2.9% vs. 1.3%; p ≤ 0.17), retroperitoneal hematoma (0.9% vs. 0.2%; p ≤ 0.01), and contrast-induced nephropathy (6.7% vs. 4.5%; p ≤ 0.03). Resource utilization was significantly higher (p <0.0001) in patients with prolonged fluoroscopy time. By multivariate analysis, prolonged fluoroscopy time was most strongly associated with prior CABG (OR ≤ 2.39), ostial lesion (OR ≤ 2.87), severe lesion calcification (OR ≤ 2.14), baseline TIMI flow 0 - 2 (OR ≤ 3.71) (all p <0.0001), lesion eccentricity (OR ≤ 1.96; p ≤ 0.0063), and peripheral arterial disease (OR ≤ 1.91; p ≤ 0.0068). CONCLUSIONS: Prolonged fluoroscopy time is associated with higher complexity of treated lesions and increased rates of periprocedural complications including early mortality, emergent CABG, contrast-induced nephropathy, and increased resource utilization.