Association of the long fluoroscopy time with factors in contemporary primary percutaneous coronary interventions

• Published in: PloS one Vol. 15; no. 8; p. e0237362
• Main Authors: Asada, Satoshi, Sakakura, Kenichi, Taniguchi, Yousuke, Yamamoto, Kei, Tsukui, Takunori, Seguchi, Masaru, Wada, Hiroshi, Momomura, Shin-ichi, Fujita, Hideo
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 10.08.2020; Public Library of Science (PLoS)
• Subjects: Angioplasty; Balloon angioplasty; Biology and Life Sciences; Calcification; Care and treatment; Catheters; Confidence intervals; Creatinine; Diabetes; Diabetes mellitus; Engineering and Technology; Fluoroscopy; Heart attack; Heart attacks; Heart surgery; Hemodialysis; Hemoglobin; Hypertension; Lesions; Medical imaging; Medical treatment; Medicine; Medicine and Health Sciences; Methods; Mortality; Myocardial infarction; Patient outcomes; Physical Sciences; Regression analysis; Reperfusion; Research and Analysis Methods; Statistical analysis; Supervision; Tortuosity; Variables; Veins & arteries; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0237362

Since the long fluoroscopy time in primary PCI for ST-segment elevation myocardial infarction (STEMI) could be an indicator of delayed reperfusion, it should be important to recognize which types of lesions require longer fluoroscopy-time in primary PCI. The purpose of this study was to investigate the association of the long fluoroscopy-time with clinical factors in primary percutaneous coronary interventions (PCI). A total of 539 patients who underwent primary PCI were divided into the conventional fluoroscopy-time group (Q1-Q4: n = 434) and the long fluoroscopy-time group (Q5: n = 105) according to the quintile of the total fluoroscopy time in primary PCI. Univariate and multivariate logistic regression analyses were performed to find associations between clinical variables and the long fluoroscopy-time. In univariate logistic regression analysis, prevalence of diabetes mellitus, hemodialysis, and previous CABG were significantly associated with the long fluoroscopy-time. In addition, complex lesion characteristics such as lesion length, lesion angle, tortuosity, and calcification were associated with the long fluoroscopy-time. In multivariable logistic regression analysis, lesion length [per 10 mm incremental: odds ratio (OR) 1.751, 95% confidence interval (CI) 1.397-2.195, P<0.001], moderate-excessive tortuosity (vs. mild tortuosity: OR 4.006, 95% CI 1.498-10.715, P = 0.006), and moderate to severe calcification (vs. none-mild calcification: OR 1.865, 95% CI 1.107-3.140, P = 0.019) were significantly associated with the long fluoroscopy-time. In primary PCI for STEMI, diffuse long lesion, tortuosity, and moderate-severe calcification were associated with the long fluoroscopy-time. These complex features require special attention to reduce reperfusion time in primary PCI.