Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: Analysis in relation to radiationexposure parameters

Few data are available on the quantitative assessment of complexity (C), es pecially in relation to a patient's exposure to radiation. The relationship between several clinical (CFs), anatomic (AFs), and technical factors (TFs ) versus fluoroscopy time (FT) was evaluated in 402 random percutaneous tra nsluminal coronary angioplasty (PTCA) procedures. CFs were age, sex, single or multivessel disease, ejection fraction, and previous coronary artery by pass graft. AFs were assessed based on the American Heart Association/Ameri can College of Cardiology classification. TFs were multivessel PTCA, use of the double wire or double balloon technique, stenting, ostial stenting, bi furcation stenting, and intravascular ultrasonography. No CFs significantly influenced FT, whereas all AFs and TFs (except multivessel PTCA) did signi ficantly influence FT. A scoring system was developed, and two complexity i ndexes (CI) were conceived, based on which the procedures were divided into three groups: simple, medium, and complex. The mean FTs were 471 +/- 289, 805 +/- 532, and 1,190 +/- 641 (P < 0.0001), respectively. Total cine frame recordings were 1,119 +/- 572, 1,265 +/- 644 (P = 0.0355), and 1,418 +/- 7 85 (P < 0.0001 vs. simple; P = NS vs. medium). The dose/area product measur ement was 65.8 +/- 41.4, 93 +/- 58.5 (P < 0.0001), and 116.7 +/- 72.8 (P < 0.0001 vs. simple; P = 0.00159 vs, medium), respectively. In our series, CI was directly related to AF and TF, but not to CF. Comparison of PTCA proce dures and definition of appropriate FT should consider Cls. Cathet. Cardiov asc. Intervent 51:1-9, 2000. (C) 2000 Wiley-Liss, Inc.