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Simple vs. complex coronary intervention: impact on radiation exposure to the patient and operator
Abstract
S301
.. .. pre-treatment, but not with prasugrel. As institutional surgi.. cal revascularisation rates increased, the magnitude of benefit .. .. decreased with ticagrelor and clopidogrel. Time to coronary .. .. angiography had no correlation to net clinical benefit. .. Conclusion: The findings of our analysis suggest that pre.. .. treatment may not be universally beneficial and a tailored .. .. assessment of each patient’s individual ischaemic and bleed.. .. ing risk may identify those most likely to benefit. .. .. http://dx.doi.org/10.1016/j.hlc.2015.06.442 .. .. http://dx.doi.org/10.1016/j.hlc.2015.06.443 442 .. .. 443 .. Should P2Y12 inhibitors be administered .. .. Simple vs. complex coronary intervention: empirically in Non-ST-Elevation Acute .. .. impact on radiation exposure to the patient Coronary Syndrome management prior to .. .. and operator coronary angiography? A decision-making .. analysis into the value of pre-treatment .. .. J. Crowhurst 1,2,∗ , M. Whitby 1 , D. .. Murdoch 1,2 , C. Raffel 1 , A. Lee 1 , E. Shaw 1 , ∗ J. Gunton , T. Hartshorne, A. Chuang, D. .. .. D. Walters 1,2 Chew .. .. 1 .. Flinders Medical Centre- Cardiology The Prince Charles Hospital, Chermside, QLD, .. Department, Adelaide, SA, Australia .. Australia .. 2 University of Queensland, Brisbane, QLD, .. Background: Current guidelines recommend pre- ... Australia . treatment with a P2Y12 inhibitor for all patients with ... non-ST-elevation acute coronary syndrome (NSTE-ACS) ... Introduction: Invasive percutaneous coronary interven. before the coronary anatomy is known, however there are no ... tion (PCI) has developed greatly over the last 20 years. As . randomised trials to support this practice. We put forward a .. the procedures become longer and more complex, the radia. new approach to the question of pre-treatment by applying ... tion exposure to the patient and the operator also increases. . a decision-making analysis based on the available evidence ... This study aimed to quantify the difference between simple .. and complex PCI in terms of radiation dose to the patient and from randomised trials. .. Methods: A decision analysis model was constructed com- ... the primary operator. paring the three different P2Y12 inhibitors in addition to ... Methods: Between August and November 2014, radiation . aspirin in patients with NSTE-ACS. Based on clinical trial ... dose to the patient was measured using a calibrated dose data, the cumulative probability of 30-day mortality, myocar- ... area product (DAP) metre in the angiography X-ray system. . dial infarction (MI) and major bleeding were determined, ... Dose to the primary operator was measured using a digital and subsequently used to calculate the net clinical benefit. ... dosimeter (InstadoseTM ) that was read after each procedure. . Sensitivity analysis was performed to assess the relationship ... Other measures collected were patient weight, contrast media . between net clinical benefit and ischaemic risk, bleeding risk, .. volume and fluoroscopy time. Simple PCI was determined .. .. as single vessel intervention that did not require additional time to angiography and surgical revascularisation rate. . Results: Pre-treatment with ticagrelor and clopidogrel was ... equipment to a guide wire, balloon and stent. Complex PCI associated with net clinical benefit in patients at all levels of ... was determined as multi vessel intervention, chronic total . ischaemic risk except those in the lowest quartile (GRACE ... occlusions, intervention to vein grafts or single vessel interscore 0-3%) whereas prasugrel resulted in no net benefit at all ... vention that required the use of rotablation, intra-vascular . levels of ischaemic risk. Increasing bleeding risk was associ- ... ultrasound or optical coherence tomography. ated with net clinical benefit with ticagrelor and clopidogrel ... Results: See table: means (95% CI) .. .. .. . N= Weight (Kg) DAP (Gycm2 ) Fluoro...time (minutes) Contrast media (cc) Operator dose (Sv) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Overall 185 87 (86-87) 126 (122-128) 22.0 (21.3-22.6) 185 (188-182) 45.9 (48.4- 43.4) .. .. . Simple 119 88 (84-91) 106 (96-116) 17.5 (15.6-19.4) 173 (184-163) 40.5 (49.4- 31.6) .. .. . Complex 66 84 (79-88) 158 (136-181) 29.9 (25.1-34.7) 204 (205-230) 55.9 (74.1- 37.7) .. . P-value 0.176 <0.001 <0.001 0.009 0.094 in low-risk sAVR (n=135) group compared to TAVI (7.8±3.3 v 5.6±2.5; p < 0.0001) with similar 30-day mortality (2% v 3%). High-risk sAVR had older patients compared to lowrisk sAVR group (80.6±3.8 v 79±3 v, p = 0.001) with higher mortality at 30 days (8.4% v 2%) and 1 year (14% v 6%). Conclusion: sAVR is ideal for low-risk patients. TAVI is safer for older patients with higher clinical risk.
Conclusion: Despite the significantly higher radiation and fluoroscopy used in complex PCI, operator exposure was not significantly higher. http://dx.doi.org/10.1016/j.hlc.2015.06.444
S301
.. .. pre-treatment, but not with prasugrel. As institutional surgi.. cal revascularisation rates increased, the magnitude of benefit .. .. decreased with ticagrelor and clopidogrel. Time to coronary .. .. angiography had no correlation to net clinical benefit. .. Conclusion: The findings of our analysis suggest that pre.. .. treatment may not be universally beneficial and a tailored .. .. assessment of each patient’s individual ischaemic and bleed.. .. ing risk may identify those most likely to benefit. .. .. http://dx.doi.org/10.1016/j.hlc.2015.06.442 .. .. http://dx.doi.org/10.1016/j.hlc.2015.06.443 442 .. .. 443 .. Should P2Y12 inhibitors be administered .. .. Simple vs. complex coronary intervention: empirically in Non-ST-Elevation Acute .. .. impact on radiation exposure to the patient Coronary Syndrome management prior to .. .. and operator coronary angiography? A decision-making .. analysis into the value of pre-treatment .. .. J. Crowhurst 1,2,∗ , M. Whitby 1 , D. .. Murdoch 1,2 , C. Raffel 1 , A. Lee 1 , E. Shaw 1 , ∗ J. Gunton , T. Hartshorne, A. Chuang, D. .. .. D. Walters 1,2 Chew .. .. 1 .. Flinders Medical Centre- Cardiology The Prince Charles Hospital, Chermside, QLD, .. Department, Adelaide, SA, Australia .. Australia .. 2 University of Queensland, Brisbane, QLD, .. Background: Current guidelines recommend pre- ... Australia . treatment with a P2Y12 inhibitor for all patients with ... non-ST-elevation acute coronary syndrome (NSTE-ACS) ... Introduction: Invasive percutaneous coronary interven. before the coronary anatomy is known, however there are no ... tion (PCI) has developed greatly over the last 20 years. As . randomised trials to support this practice. We put forward a .. the procedures become longer and more complex, the radia. new approach to the question of pre-treatment by applying ... tion exposure to the patient and the operator also increases. . a decision-making analysis based on the available evidence ... This study aimed to quantify the difference between simple .. and complex PCI in terms of radiation dose to the patient and from randomised trials. .. Methods: A decision analysis model was constructed com- ... the primary operator. paring the three different P2Y12 inhibitors in addition to ... Methods: Between August and November 2014, radiation . aspirin in patients with NSTE-ACS. Based on clinical trial ... dose to the patient was measured using a calibrated dose data, the cumulative probability of 30-day mortality, myocar- ... area product (DAP) metre in the angiography X-ray system. . dial infarction (MI) and major bleeding were determined, ... Dose to the primary operator was measured using a digital and subsequently used to calculate the net clinical benefit. ... dosimeter (InstadoseTM ) that was read after each procedure. . Sensitivity analysis was performed to assess the relationship ... Other measures collected were patient weight, contrast media . between net clinical benefit and ischaemic risk, bleeding risk, .. volume and fluoroscopy time. Simple PCI was determined .. .. as single vessel intervention that did not require additional time to angiography and surgical revascularisation rate. . Results: Pre-treatment with ticagrelor and clopidogrel was ... equipment to a guide wire, balloon and stent. Complex PCI associated with net clinical benefit in patients at all levels of ... was determined as multi vessel intervention, chronic total . ischaemic risk except those in the lowest quartile (GRACE ... occlusions, intervention to vein grafts or single vessel interscore 0-3%) whereas prasugrel resulted in no net benefit at all ... vention that required the use of rotablation, intra-vascular . levels of ischaemic risk. Increasing bleeding risk was associ- ... ultrasound or optical coherence tomography. ated with net clinical benefit with ticagrelor and clopidogrel ... Results: See table: means (95% CI) .. .. .. . N= Weight (Kg) DAP (Gycm2 ) Fluoro...time (minutes) Contrast media (cc) Operator dose (Sv) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Overall 185 87 (86-87) 126 (122-128) 22.0 (21.3-22.6) 185 (188-182) 45.9 (48.4- 43.4) .. .. . Simple 119 88 (84-91) 106 (96-116) 17.5 (15.6-19.4) 173 (184-163) 40.5 (49.4- 31.6) .. .. . Complex 66 84 (79-88) 158 (136-181) 29.9 (25.1-34.7) 204 (205-230) 55.9 (74.1- 37.7) .. . P-value 0.176 <0.001 <0.001 0.009 0.094 in low-risk sAVR (n=135) group compared to TAVI (7.8±3.3 v 5.6±2.5; p < 0.0001) with similar 30-day mortality (2% v 3%). High-risk sAVR had older patients compared to lowrisk sAVR group (80.6±3.8 v 79±3 v, p = 0.001) with higher mortality at 30 days (8.4% v 2%) and 1 year (14% v 6%). Conclusion: sAVR is ideal for low-risk patients. TAVI is safer for older patients with higher clinical risk.
Conclusion: Despite the significantly higher radiation and fluoroscopy used in complex PCI, operator exposure was not significantly higher. http://dx.doi.org/10.1016/j.hlc.2015.06.444