Search Results (180)

Complex percutaneous coronary intervention (PCI) represents a growing proportion of contemporary coronary revascularization, driven by aging populations, increasing comorbidity burden, and advances in interventional techniques. Complex PCI encompasses a spectrum of anatomically and procedurally challenging lesions, including left main disease, bifurcation lesions requiring two-stent strategies, chronic total occlusions, long stent lengths, severe calcification requiring atherectomy, and multivessel revascularization. Antithrombotic therapy, comprising antiplatelet and anticoagulant agents, is essential for preventing stent thrombosis and other ischemic events in both the early and long-term phases after PCI. While antithrombotic therapy mitigates ischemic risks associated with complex PCI, these patients frequently carry a high bleeding risk, thus making the choice of antithrombotic regimen challenging. Recent guideline recommendations emphasize balancing ischemic and bleeding risks rather than relying solely on procedural complexity. This review synthesizes contemporary evidence, guideline recommendations, and clinical considerations for antithrombotic therapy after complex PCI. Full article

Background and Clinical Significance: The Coronary Sinus Reducer (CSR) is a percutaneous therapeutic option for patients with refractory angina who are unsuitable for further myocardial revascularization. The procedure has a generally favorable safety profile, with a low rate of reported procedural complications. To our knowledge, major atrioventricular (AV) conduction disturbances during CSR implantation have not been previously described. This case highlights a rare but clinically relevant intraprocedural complication; Case Presentation: A 71-year-old man with multivessel coronary artery disease and previous coronary artery bypass grafting was referred for CSR implantation because of refractory angina despite optimal medical therapy and lack of further revascularization options. The procedure was performed via a right jugular venous approach. Baseline electrocardiography showed right bundle branch block and findings consistent with previous inferior myocardial infarction, without definite criteria for left anterior fascicular block. During coronary sinus cannulation, the patient developed transient complete AV block, resulting in an approximately 8–10-second ventricular pause without a stable ventricular escape rhythm. The conduction disturbance resolved after catheter withdrawal and repositioning. Given the severity of the event, a temporary transvenous pacemaker was inserted via the right femoral vein, allowing safe completion of CSR implantation. At three-month follow-up, angina had improved from Canadian Cardiovascular Society class III to class I, and no recurrent advanced AV block was documented; Conclusions: Transient complete AV block may occur during CSR implantation, particularly during coronary sinus manipulation and possibly in patients with pre-existing conduction disease. Careful catheter handling, prompt recognition of conduction disturbances, and immediate availability of temporary pacing support should be considered in selected high-risk patients undergoing CSR implantation. Full article

Non-ST-segment elevation myocardial infarction (NSTEMI) has become the predominant form of acute coronary syndrome (ACS) and is frequently associated with multivessel coronary artery disease (MVD). Patients presenting with NSTEMI and MVD represent a particularly high-risk population characterized by advanced age, comorbidities, and an increased atherosclerotic burden. Although advances in pharmacological therapy and early invasive management have improved prognosis, the optimal revascularization strategy in this setting remains uncertain. In contrast to ST-segment elevation myocardial infarction (STEMI), where randomized controlled trials consistently support complete revascularization, evidence in NSTEMI with MVD is limited and is largely derived from observational studies and registry data. This has generated ongoing debate regarding whether complete revascularization offers superior outcomes compared with culprit-only percutaneous coronary intervention (PCI), and whether non-culprit lesions should be treated during the index procedure (immediate strategy) or in a staged manner. Current data suggest that complete PCI is generally associated with reduced recurrent ischemia, reinfarction, and repeat revascularization, with potential long-term survival benefits. However, patient comorbidities, lesion complexity, and procedural risk continue to influence outcomes, highlighting the importance of individualized decision-making. This narrative review synthesizes contemporary evidence on PCI-based revascularization strategies in NSTEMI with MVD, focusing on two central aspects: the extent of revascularization (complete versus incomplete) and the timing of intervention (single-stage versus staged). By integrating findings from registries, randomized trials and guideline recommendations, the review identifies areas of consensus, persisting uncertainties, and key evidence gaps. Ultimately, it underscores the need for large, dedicated trials to guide practice and optimize outcomes for NSTEMI patients with multivessel coronary disease. Full article

Multivessel coronary artery disease is observed in a substantial proportion of patients presenting with ST-segment elevation myocardial infarction (STEMI) and identifies a higher-risk phenotype characterized by larger atherosclerotic burden, recurrent ischemic events, and greater need for subsequent revascularization. Over the past decade, randomized evidence has progressively shifted the interventional paradigm from culprit-lesion-only primary percutaneous coronary intervention (PCI) toward complete revascularization in hemodynamically stable STEMI patients with suitable non-culprit lesions. Nevertheless, several clinically relevant questions remain unresolved, including the optimal criteria for selecting non-culprit lesions, the relative value of angiography, coronary physiology, and intracoronary imaging, the timing of complete revascularization, and the management of patients presenting with cardiogenic shock. Angiography-guided complete revascularization has the strongest evidence base, while physiology-guided approaches may reduce unnecessary PCI but have not demonstrated superiority over angiography-guided strategies in direct randomized comparisons. Intracoronary imaging offers unique information on plaque vulnerability and PCI optimization, although dedicated outcome trials in STEMI remain limited. The timing of complete revascularization has also evolved, with contemporary trials supporting early treatment in selected stable patients but not establishing a universal immediate strategy. This review summarizes current evidence, unresolved controversies, and emerging directions regarding strategies and timing of complete revascularization in STEMI patients with multivessel disease. Full article

Background: Carotid atherosclerosis is a recognised manifestation of systemic vascular disease, and its association with coronary artery disease (CAD) has been well described. However, previous studies have largely been conducted under conventional diagnostic conditions and have focused on carotid plaque, intima–media thickness, or simple present-versus-absent stenosis classifications, rather than duplex-derived haemodynamic markers across the spectrum of angiographic CAD burden. The COVID-19 pandemic and post-pandemic period changed referral patterns and created more variable cardiovascular presentations, including symptoms that could resemble or mask obstructive CAD. Therefore, we investigated whether the established association between carotid stenosis severity and CAD burden remains detectable in a diagnostically heterogeneous real-world cohort, and whether routinely available carotid duplex haemodynamic parameters provide a clinically relevant signal in this setting. Methods: This single-centre, cross-sectional study was performed as a carotid-focused secondary analysis of the BG Study cohort. We included 902 consecutive patients who underwent invasive coronary angiography between 2021 and 2023 and carotid duplex ultrasonography during the same hospitalisation. CAD burden was defined according to the number of major coronary vessels with ≥70% diameter stenosis and classified as no CAD, one-vessel, two-vessel, or three-vessel disease. Carotid duplex parameters included peak systolic velocities of the common, internal, and external carotid arteries, as well as ICA stenosis severity graded according to NASCET criteria. Associations with CAD burden were assessed using a staged statistical approach combining χ² tests, Kruskal–Wallis tests with post hoc pairwise comparisons, Spearman correlation, inverse probability weighting, and ordered logistic regression. Results: The prevalence of measured ICA stenosis of any grade and severe ICA stenosis increased with greater CAD burden (both p < 0.001). Median PSV values of the bilateral ICAs and ECAs differed significantly across CAD groups on global intergroup testing. Post hoc pairwise analyses showed that significant corrected differences were concentrated between patients without CAD and those with multivessel or three-vessel CAD, particularly for ICA stenosis measures and bilateral ECA PSV. Spearman analysis demonstrated weak but statistically significant correlations between carotid parameters and CAD burden (ρ = 0.085–0.134). After inverse probability weighting, covariate balance was achieved, with all post-IPW standardised mean differences being <0.01. In ordered logistic regression (OLR) analysis, patient-reported history of carotid stenosis (OR 2.25, 95% CI 1.38–3.67; p < 0.001), right external carotid artery PSV per 10 cm/s (OR 1.31, 95% CI 1.09–1.57; p = 0.004), left ICA PSV per 10 cm/s (OR 1.17, 95% CI 1.01–1.36; p = 0.034), and left ICA stenosis per 10% (OR 1.24, 95% CI 1.11–1.39; p < 0.001) were independently associated with higher CAD burden. Exploratory ratio-based analyses showed that the ECA/CCA PSV ratio was associated with CAD presence and higher CAD burden, whereas the ICA/CCA ratio showed weaker associations; neither ratio-based index outperformed absolute ECA PSV. Conclusions: In this carotid-focused secondary analysis of a pandemic-era angiography cohort, carotid stenosis severity and duplex-derived haemodynamic parameters were independently but modestly associated with increasing angiographic CAD burden. These findings support carotid duplex markers as adjunctive indicators of systemic atherosclerotic burden rather than standalone tools for CAD detection or treatment decision-making. Future validation in vascular surgery populations is warranted to determine whether routinely available carotid duplex parameters can contribute to targeted cardiovascular risk recognition before major vascular procedures. Full article

Background: Left ventricular outpouchings remain among the most difficult structural abnormalities to classify in clinical practice. The differential diagnosis usually includes true aneurysm, pseudoaneurysm, diverticulum, and less clearly defined chronic post-ischemic remodeling patterns. Although multimodality imaging is central to preoperative assessment, it may still overstate diagnostic certainty in complex chronic lesions. Case Presentation: We report the case of a 66-year-old man with chronic coronary syndrome and severe multivessel coronary artery disease in whom transthoracic echocardiography, computed tomography, ventriculography, and cardiac magnetic resonance consistently suggested a basal lateral left ventricular pseudoaneurysm, with imaging findings compatible with an associated mural thrombotic component. Because of the coexistence of surgically significant coronary disease, the patient was referred for operative treatment. Intraoperatively, however, the expected pseudoaneurysmal cavity was not identified. Instead, two posterolateral fibro-calcific left ventricular formations were found in a surgically difficult area, with an appearance that did not correlate convincingly with any preoperative imaging study. Given their calcified aspect, difficult exposure, and the high risk of additional surgical manipulation, no direct intervention was performed on these structures, and only myocardial revascularization was undertaken. The postoperative course was favorable. Discussion: The case highlights a clinically important limitation of multimodality imaging: concordant imaging does not necessarily equal an anatomically correct diagnosis. The discrepancy between imaging and operative findings raises unresolved questions as to whether the lesion represented small chronic aneurysmal formations, an unusual chronic pseudoaneurysm, a calcified diverticular process, multiple fibro-calcific post-infarction outpouchings, or another form of chronic left ventricular remodeling. Rather than forcing a definitive label unsupported by pathology, the case is better understood as a diagnostic gray-zone lesion. Conclusions: Even comprehensive imaging may remain incomplete when evaluating unusual left ventricular outpouchings in ischemic patients. This case underscores the need for cautious diagnostic language, close correlation with operative findings, and broader discussion regarding the classification of chronic left ventricular parietal lesions. Full article

Background/Objectives: Metabolic syndrome (MetS) affects more than 1.5 billion adults worldwide and is present in 37–70% of STEMI patients. Its ten-year prognostic value after primary PCI—particularly for heart failure, which is rarely examined as a primary endpoint—remains incompletely characterized. Methods: In total, 506 STEMI patients treated with primary PCI (December 2009–June 2010) were followed for ten years. MetS was defined at admission using AHA/NHLBI criteria. Co-primary endpoints were all-cause mortality, MACE, and hospitalization for heart failure. Multivariable Cox regression was adjusted for sex, age, LVEF, previous MI, Killip class, and multivessel disease. Four ML models were evaluated by 10-fold stratified cross-validation with SHAP-based feature, with a Fine–Gray subdistribution-hazard sensitivity analysis for heart failure. Feature attribution used TreeSHAP on XGBoost and permutation importance on a Random Survival Forest. Results: MetS(+) patients were older, more frequently female, and had higher SYNTAX scores (all p < 0.05). MetS was present in 216 patients (42.7%). It did not independently predict mortality (HR 1.09, p = 0.66) but did predict MACE (HR 1.47, p = 0.028) and heart failure hospitalization (cause-specific HR 2.86, 95% CI 1.57–5.22; Fine–Gray HR 2.61, 95% CI 1.44–4.75; both p ≤ 0.002). The null mortality finding coincided with differential statin discontinuation and a selective obesity paradox: in non-obese patients, MetS doubled mortality (42.9% vs. 21.1%, p = 0.008), while in obese patients, the effect disappeared (26.5% vs. 23.2%, p = 0.529). Two independent ML frameworks ranked the cumulative number of MetS criteria—rather than the binary diagnosis—among the leading individual-level features for heart failure prediction (Random Survival Forest c-index 0.843). Conclusions: In primary PCI-treated STEMI survivors, MetS independently predicts ten-year MACE and heart failure but not mortality. The number of MetS criteria at baseline, rather than the binary classification, was more strongly associated with heart failure risk; whether prospective modification of individual components reduces this risk requires dedicated interventional studies. The lean MetS-positive phenotype may represent a candidate subgroup warranting further investigation. Full article

Background: Accurate evaluation of stent implantation during percutaneous coronary intervention (PCI) is essential to reduce both early and late adverse events. Conventional coronary angiography, although routinely used, has limited spatial resolution and may fail to detect subtle mechanical abnormalities in implanted stents. Enhanced stent visualization (ESV) is an X-ray-based post-processing technique that improves delineation of stent struts without additional contrast or intracoronary instrumentation. Methods: We report a retrospective case series of five patients who underwent complex PCI where ESV was used as an adjunctive imaging modality. Clinical scenarios included left main interventions, bifurcation lesions, multivessel disease, and acute coronary syndromes. The ability of ESV to detect mechanical complications not evident on angiography was assessed. The impact of ESV on procedural decision-making was also assessed. Results: ESV enabled identification of mechanical complications in all cases, including stent fracture, stent loss, stent dislodgement, stent underexpansion, and geographical miss. These findings were not clearly appreciable when using angiography alone. In each case, ESV directly influenced intraprocedural management, prompting immediate corrective actions such as additional stent implantation, stent retrieval, or further optimization with post-dilatation or intravascular lithotripsy. This resulted in improved procedural outcomes and optimized stent deployment. Conclusions: In this small retrospective case series, ESV provided incremental diagnostic value over conventional angiography by detecting otherwise unrecognized mechanical complications and guiding real-time procedural optimization. While these findings suggest a potential role for ESV in complex PCIs, larger prospective studies are required to confirm its clinical impact. Full article

Background: Segmental arterial mediolysis (SAM) is a non-inflammatory vasculopathy that primarily affects the abdominal visceral arteries leading to hemorrhage, ischemia, or pseudoaneurysms. Its presentation can be mimicked by other vasculopathies including vasculitis involving the medium-sized blood vessels making it difficult to diagnose. Case Presentation: A 55-year-old woman presented with a two-hour history of sudden-onset, severe epigastric pain radiating to the chest. She was noted to be hypotensive with low hemoglobin 8.8 g/dL suspicious for a hemorrhagic cause. Her case was complicated by elevated international normalized ratio 3.7 in the setting of warfarin therapy for the mechanical mitral valve. The remainder of her complete blood count, complete metabolic panel, inflammatory markers, autoantibody serologies, and infectious testing were negative. Abdominal computed tomography angiogram revealed hemoperitoneum, bilateral renal infarctions, a large mesenteric hematoma, aneurysmal disease of the common hepatic and inferior mesenteric arteries, thrombosis and proximal dissection of the superior mesenteric artery, acute thrombosis of the left external iliac vein, and multiple sites of arterial extravasation from the pancreaticoduodenal artery and its branches. Mesenteric artery angiogram showed multivessel visceral artery aneurysms and stenoses characteristic of SAM for which she underwent transcatheter arterial embolization of the bleeding vascular bed. We provide a narrative literature review with a focus on common presentations and differentiating characteristics of vasculopathies that can involve medium-sized blood vessels. It is important to accurately diagnose SAM and its potential mimics as management strategies differ. Conclusions: SAM presents with medium vessel vasculopathy without vasculitis. Differentiation from mimics can be difficult but aided by familiarity of their characteristic findings and differentiating clinical characteristics. Full article

Background: The extent of coronary artery disease (CAD) is a major determinant of prognosis in patients with myocardial infarction (MI). While structured exercise is known to be cardioprotective, the association between habitual daily physical activity and angiographic CAD extension remains insufficiently characterized. Methods: In this prospective observational study, 269 patients were hospitalized with acute MI underwent coronary angiography. Habitual daily physical activity during the four weeks preceding admission was assessed using 10-point self-reported daily preadmission effort questions to help the patients to report a final effort score. CAD extension was classified as single-, double- or triple-vessel disease. Differences in daily effort across CAD categories were evaluated using the Kruskal–Wallis test. Independent predictors of CAD extension were identified using ordinal logistic regression adjusted for age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia and body mass index. Results: Daily preadmission effort decreased progressively with increasing CAD severity (mean scores: 7.44 in single-vessel, 4.93 in double-vessel and 3.69 in triple-vessel disease; p < 0.0001). In multivariable ordinal logistic regression analysis, older age, hypertension, diabetes mellitus and hyperlipidemia were independently associated with greater CAD extension. Higher daily preadmission effort was strongly and independently associated with lower CAD severity; each one-point increase in effort score was associated with a 46% reduction in the odds of more extensive CAD (odds ratio 0.54, 95% confidence interval 0.45–0.64; p < 0.0001). Conclusions: Greater habitual daily physical activity prior to myocardial infarction is independently associated with less extensive coronary artery disease. Assessment of daily preadmission effort may provide clinically useful information regarding coronary disease burden and highlights the potential importance of everyday physical activity in cardiovascular prevention. These findings should be interpreted with caution given the use of a non-validated, self-reported measure of physical activity and the observational study design. Full article

Coronary artery disease (CAD) often coexists with severe aortic stenosis (AS) in patients undergoing transcatheter aortic valve implantation (TAVI), posing a complex diagnostic and therapeutic challenge. As TAVI is increasingly used for younger, lower-risk patients, managing CAD is becoming a personalized, long-term clinical concern. This narrative review summarizes the current evidence on coronary assessment and revascularization strategies in individuals with severe AS. Invasive coronary angiography remains the leading method for anatomical coronary imaging, but coronary computed tomography angiography is emerging as a reliable alternative that may reduce unnecessary invasive procedures in certain patients. The routine performance of PCI before TAVI is under increasing scrutiny, and available data support a more selective approach based on lesion significance, CAD complexity, procedural timing, and anticipated need for future coronary access. Significant uncertainties remain concerning the physiological evaluation of lesions, the timing and completeness of revascularization, and the treatment of left main or multivessel disease. Additional phenotype-specific and longitudinal studies are needed to improve management algorithms for this population. Full article

Background. Despite technological innovations and improvements in stents and devices, sex-related discrepancies are still reported in the outcomes after ST-segment elevation myocardial infarction (STEMI), depending on biological and sex-specific pathophysiological differences, which have not been completely understood. The aim of the present study was to provide real-world data on the prognostic role of sex among patients with STEMI, enclosed into a recent up-to-date international registry. Methods. The ISACS-STEMI COVID-19 is a large-scale retrospective registry, including STEMI patients treated with mechanical reperfusion between 1 March and 30 June, 2019 and 2020. Patients, treated in 109 centers across Europe, Latin America, Southeast Asia, and North Africa, were grouped according to sex. Primary endpoint: In-hospital mortality; secondary endpoints: Time delay, 30-day mortality, and postprocedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow. Results. We included 16,083 patients, 24.3% females (54.3% hospitalized in 2019, 45.7% in 2020). Women with STEMI were older, more often diabetic and hypertensive (p < 0.001), with a higher prevalence of hypercholesterolemia (p = 0.02), longer ischemia time (p = 0.01), ambulance referral (p = 0.03) and cardiogenic shock at presentation (p = 0.05), but less frequently smokers, with a previous cardiovascular event (p < 0.001) or anterior STEMI (p = 0.03) as compared to males. Preprocedural TIMI 0 flow, multivessel disease, need for thrombectomy (p < 0.001 and p = 0.001, respectively), use of Glycoprotein IIbIIIa inhibitors or cangrelor, radial access and implantation of drug-eluting stents (p < 0.001, p < 0.001 and p = 0.001, respectively) were also more common in men. Impaired postprocedural epicardial reperfusion (TIMI flow 0–2) was observed more frequently in females as compared to males (10% vs. 7.2%; adjusted OR [95% CI] = 1.30 [1.13–1.49], p = 0.01). In-hospital mortality was 5.8%, significantly higher among women (8.3% vs. 5%, p < 0.001, adjusted HR [95% CI] = 1.26 [1.06–1.5], p = 0.01). Similar data were observed for 30-day mortality (10.3% vs. 6.2%, p < 0.001, adjusted HR [95% CI] = 1.22 [1.06–1.38], p = 0.007). Conclusions. Among STEMI patients being treated with the most updated standard of care for primary percutaneous coronary intervention, female sex is still associated with higher complexity and impaired prognosis, displaying suboptimal epicardial reperfusion and increased in-hospital and 30-day mortality. Full article

Background/Objectives: Fractional flow reserve (FFR) is the reference standard for assessing the functional significance of intermediate coronary stenoses and guiding revascularization. Although a universal ischemic threshold is applied to all epicardial vessels, potential physiological differences between coronary territories remain insufficiently explored. The aim of this study was to evaluate whether the functional significance of intermediate coronary stenoses differs according to coronary artery and to assess the clinical outcomes of FFR-guided deferral across coronary territories. Methods: This single-center retrospective study included patients who underwent single-vessel FFR assessment for angiographically intermediate lesions between 2019 and 2022. Patients with left main disease or multivessel physiological assessment were excluded. Clinical characteristics, FFR values, and long-term outcomes were analyzed according to the investigated coronary artery. Major adverse cardiovascular events (MACE) were defined as a composite of death, myocardial infarction, and urgent revascularization. Results: A total of 310 patients (corresponding to 310 coronary arteries) were included: 211 LAD, 68 RCA, and 31 LCX lesions. Overall, 18.7% of lesions had a positive FFR (≤0.80). The only variable identified in univariable analysis as being associated with FFR positivity was the coronary artery evaluated (p < 0.001). Positive FFR values were observed in 24.6% of LAD lesions, compared with 8.8% in the RCA and none in the LCX. Among patients with negative FFR for whom revascularization was deferred, five-year MACE-free survival was similar across coronary territories (p = 0.12). Conclusions: The functional significance of intermediate coronary stenoses varies according to the coronary territory, with LAD lesions more frequently reaching ischemic thresholds. However, deferral of revascularization based on negative FFR is associated with favorable long-term outcomes across all vessels, supporting a vessel-specific physiological interpretation of coronary stenoses. Full article

Background and Objectives: Residual coronary anatomical complexity following culprit-lesion-only percutaneous coronary intervention (PCI) remains a major determinant of clinical outcomes in patients with multivessel coronary artery disease (CAD). Platelet distribution width (PDW), a marker of platelet heterogeneity and activation, has been associated with adverse cardiovascular outcomes; however, its relationship with post-procedural residual disease burden remains unclear. This study aimed to evaluate the association between PDW and residual SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score and to determine its incremental predictive value beyond established clinical variables. Materials and Methods: In this retrospective, single-center study, 140 patients with multivessel CAD undergoing culprit-lesion-only PCI followed by planned staged revascularization were included. Clinical presentation was categorized as chronic coronary syndrome (CCS), non-ST-elevation myocardial infarction (NSTEMI), or ST-elevation myocardial infarction (STEMI). Residual SYNTAX score was calculated after the index procedure, and patients were stratified into low (≤22) and high (≥23) groups. Associations between PDW and residual SYNTAX score were assessed using correlation and regression analyses. Model discrimination and incremental predictive value were evaluated using ROC analysis, hierarchical logistic regression, and reclassification metrics. Nonlinear relationships were explored using restricted cubic spline analysis, and clinical utility was assessed by decision curve analysis. Results: PDW was significantly correlated with residual SYNTAX score (Spearman ρ = 0.503, p < 0.001) and increased progressively across SYNTAX severity strata and clinical presentation groups. In multivariable analysis, PDW remained independently associated with high residual SYNTAX score (OR 1.38, 95% CI 1.07–1.82, p = 0.016). The addition of PDW to a hierarchical clinical model significantly improved model performance (ΔR² = 0.049, p = 0.012). Although the improvement in area under the curve (AUC) was modest, reclassification analyses demonstrated significant net reclassification and discrimination improvements. Spline analysis revealed a nonlinear relationship, with a marked increase in risk beyond PDW levels of approximately 13 fL. Decision curve analysis confirmed the clinical utility of PDW across a range of threshold probabilities. Conclusions: PDW is independently associated with post-procedural coronary anatomical complexity and provides incremental predictive value beyond established clinical variables. However, PDW should be interpreted as a biomarker reflecting platelet heterogeneity within a thromboinflammatory context, without the ability to distinguish between acute and chronic components. Full article

Background/Objectives: Cardiovascular interventions require prolonged fluoroscopy, which increases the risk of radiation. Diagnostic Reference Levels (DRLs), set at the 75th percentile of the dose distribution, are vital benchmarks for dose optimization. Following the release of national DRLs by the Korea Disease Control and Prevention Agency in March 2025, this study established institutional DRLs at a tertiary center to evaluate local optimization against national and international standards. Methods: This study analyzed radiation doses from 2022 to 2024 using DICOM Radiation Dose Structured Reports data from a single center’s angiography system. The total kerma-area product values and fluoroscopy times were evaluated across the categorized procedures. Following the International Commission on Radiological Protection guidelines, institutional DRLs were established at the 75th percentile of the dose distribution to benchmark against national and international DRLs. Results: Analysis of 1663 radiation dose structured reports established institutional DRLs, with the total kerma-area product ranging from 23.43 Gy·cm² for coronary angiography to 329.45 Gy·cm² for chronic total occlusion interventions. Complexity significantly increased the radiation burden; multivessel percutaneous coronary intervention and acute myocardial infarction nearly doubled the doses and fluoroscopy times in single-vessel interventions. Although the diagnostic procedures were cine image-driven, for moderate-complexity interventions, the contribution of fluoroscopy was greater. Conclusions: These findings support institutional optimization and development of safety guidelines to enhance patient protection during high-complexity cardiovascular procedures. Full article