Determinants of Radiation Exposure and Radiation Overexposure During Percutaneous Coronary Intervention. A Real-World Study of 10,634 Procedures With Development of a Pragmatic Radiation-Alert Risk Score

A study analyzed 10,634 consecutive percutaneous coronary intervention (PCI) procedures performed between January 2008 and May 2018 to determine the prevalence and predictors of radiation overexposure. Radiation overexposure occurred in 99 procedures (0.93%), and was five times more frequent during complex PCI (2.1%) compared to standard procedures (0.4%). Complex PCI represented 32.5% of all procedures and included unprotected left main coronary artery, rotational atherectomy, chronic total occlusion, and bifurcation/trifurcation interventions. Independent predictors of higher radiation exposure were body mass index, male sex, chronic total occlusion, rotational atherectomy, bifurcation, and treatment of two or more vessels. A pragmatic score developed based on early clinical and procedural variables demonstrated good discriminatory ability (area under the curve 0.772) and was well calibrated for identifying high-risk cases.