BACKGROUND: Improved radiation safety practices are needed across hospitals performing percutaneous coronary intervention (PCI). This study was performed to assess the temporal trend in PCI radiation doses concurrent with the conduct of a statewide radiation safety initiative. METHODS: A statewide initiative to reduce PCI radiation doses was conducted in Michigan between 2017 and 2021 and included focused radiation safety education, reporting of institutional radiation doses, and implementation of radiation performance metrics for hospitals. Using data from a large statewide registry, PCI discharges between July 1, 2016, and July 1, 2022, having a procedural air kerma (AK) recorded were analyzed for temporal trends. A multivariable regression analysis was performed to determine whether declines in procedural AK over time were attributable to changes in known predictors of radiation doses. Results: Among 131 619 PCI procedures performed during the study period, a reduction in procedural AK was observed over time, from a median dose of 1.46 (0.86–2.37) Gy in the first year of the study to 0.97 (0.56–1.64) Gy in the last year of the study ( P <0.001). The proportion of cases with an AK ≥5 Gy declined from 4.24% to 0.86% over the same time period ( P <0.0001). After adjusting for variables known to impact radiation doses, a 1-year increase in the date of PCI was associated with a 7.61% (95% CI, 7.38%–7.84%) reduction in procedural AK ( P <0.0001). Conclusions: Concurrent with the conduct of a statewide initiative to reduce procedural radiation doses, a progressive and significant decline in procedural radiation doses was observed among patients undergoing PCI in the state of Michigan.

Introduction: Given the use of potent antithrombotic agents during and after PCI, patients (pts) are at an increased risk of gastrointestinal bleeding (GIB). Hypothesis: We hypothesize that pts with a history of recent GIB have a higher risk of post-discharge readmission and mortality compared with those without a history of GIB. Methods: We linked clinical registry data from PCIs performed between 1/1/2013 and 3/31/2018 at 48 Michigan hospitals to Medicare claims. A recent history of GIB prior to PCI was defined in the clinical PCI registry as any occurrence of melena or hematemesis in the last 30 days or any history of GIB including peptic ulcer disease that may influence clinical management during this hospitalization. Primary outcomes of interest were 90-day readmission after PCI and long-term mortality. We used 1:5 propensity-matching to adjust for differences in characteristics between pts with and without a history of recent GIB. Log-rank testing was used to evaluate survival at 1 and 5 years. Fisher's exact testing was used to compare the rates of 90-day readmission after PCI. Results: Of 30,206 pts, 1.1% had a history of GIB. Pts with a history of GIB were more likely to be older, female, black, and have more cardiovascular comorbidities. After matching 1896 pts, those with a history of GIB (n=316) appeared to have decreased survival early after PCI (Fig); however, the differences in survival were not statistically significant at 1 yr (76.%3 vs. 80.1%; p=0.11) or 5 yrs (52.5% vs. 52.2%; p=0.50) (Fig). There was no significant difference in readmission rates among those with and without a history of GIB (33.5% vs. 30.2%; p=0.26). Conclusions: Pts with and without a history of recent GIB had similar risks of readmission and long-term mortality after PCI. Although a history of GIB has previously been shown to be associated with increased post-PCI bleeding complications, a recent history of GIB was not associated with long-term post-PCI outcomes.

In this prospective randomized study of the use of the Terumo glide wire compared with the standard straight wire for crossing of severely stenotic aortic valves, the glide wire was shown to significantly decrease the fluoroscopy time of the procedure and to lower by 3.4 times the need for crossover to the alternative technique.