Editor’s Choice Determinants of Fluoroscopy Time for Invasive Coronary Angiography and Percutaneous Coronary Intervention: Insights from the NCDRR

Objectives: Identifying the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). Background: ICA and PCI are significant contributors to radiation exposure from medical imaging in the US. Fluoroscopy time is a potentially modifiable determinant of radiation exposure for these procedures, but has not been well characterized in contemporary practice. Methods: We evaluated the distribution of fluoroscopy time in patients undergoing ICA and/or PCI in the CathPCI Registry R , stratifying patients by numerous clinical scenarios. Hierarchical models were used to determine patient, procedure, operator and hospital-level factors associated with fluoroscopy time for these procedures. Results: Our study included a total of 3,295,348 ICA and PCI procedures performed by 9,600 operators from January 2005 through June 2009. There was wide variation in fluoroscopy times for these procedures with median [IQR] fluoroscopy times of 2.6 [1.7–4.5] minutes for ICA, 6.7 [4.2–10.8] minutes for ICA in patients with From the Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia The Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut The Department of Medicine, Cardiology Division, and the Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, New York Departments of Radiology and Biomedical Imaging, Epidemiology and Biostatistics, Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California, San Francisco, California Denver Veterans Affairs (VA) Medical Center, Denver, Colorado The Department of Internal Medicine, University of Colorado, Denver, Colorado The Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota The Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut The Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, Connecticut The Center for Outcomes Research and Evaluation, Yale– New Haven Hospital, New Haven, Connecticut The Veterans Affairs Ann Arbor Health Services Research Ann Arbor, Michigan Development Center of Excellence and the University of Michigan, Division of Cardiovascular Medicine, Ann Arbor, Michigan Grant sponsor: American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). Conflict of interest: None of the authors have any financial interests, direct or indirect, that might have affected the reporting of this work. *Correspondence to: Reza Fazel, Emory University, Emory Clinical Cardiovascular Research Institute, Suite 528A, 1462 Clifton Rd, Atlanta 30322, GA. E-mail: [email protected] Received 7 February 2013; Revision accepted 12 May 2013 DOI: 10.1002/ccd.24996 Published online 22 May 2013 in Wiley Online Library (wileyonlinelibrary.com). VC 2013 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 82:1091–1105 (2013)