Original scientific paper
https://doi.org/10.55378/rv.50.2.1
Retrospective analysis of radiation dose according to operator experience during percutaneous coronary interventions in acute ST-elevation myocardial infarction
Hrvoje Laušić
; Faculty of Health Sciences, Split, Croatia; Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
*
Kristina Marić Bešić
; Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
Tonći Batinić
; Faculty of Health Sciences, Ruđera Boškovića 35, Split, Croatia; University Hospital Split, Split, Croatia; University of Split School of Medicine, Split, Croatia
* Corresponding author.
Abstract
Introduction: Primary percutaneous coronary intervention (pPCI) is the standard reperfusion treatment for patients with STEMI. The procedure involves exposure to ionising radiation and the administration of contrast media, with patient characteristics, procedural complexity, and operator experience potentially influencing the level of exposure. Aim: To analyze the association between operator experience and radiation dose, with particular emphasis on cumulative air kerma (CAK). Participants and Methods: A retrospective analysis was conducted on 1,140 patients with STEMI treated with pPCI between January 1, 2021, and December 31, 2025. Patients were divided according to admission troponin levels into a normal-troponin group (n = 293) and an elevated-troponin group (n = 847). Ten interventional cardiologists were categorised according to experience as senior, mid-experienced, and junior operators. CAK, fluoroscopy time, contrast media volume, age, and sex were analysed. Differences were assessed using ANOVA with Duncan’s post-hoc test, while independent predictors were analyzed using multivariable linear regression. Results: In the normal-troponin group, no significant differences were found between operator groups in CAK, fluoroscopy time, or contrast media volume. In the elevated-troponin group, operator experience was significantly associated with CAK (F = 11.6; p < 0.001), fluoroscopy time (F = 4.2; p = 0.0151), and contrast media volume (F = 13.9; p < 0.001). The highest mean CAK was recorded among junior operators (2254.2 mGy), and the lowest among mid-experienced operators (1561.5 mGy). Multivariable analysis identified sex and age as independent predictors of higher CAK, whereas operator experience was not an independent predictor. Greater operator experience was independently associated with lower contrast media use. Conclusion: The association between operator experience and procedural parameters was most pronounced in patients with elevated troponin levels. After adjustment, CAK was primarily associated with patient characteristics, whereas contrast media use remained associated with operator experience. Optimization of pPCI should include the ALARA principle, individualized procedures, rational use of contrast media, and continuous education and supervision of less experienced operators.
Keywords
STEMI; primary percutaneous coronary intervention; cumulative air kerma; fluoroscopy; contrast media; operator experience; radiation protection
Hrčak ID:
352453
URI
Publication date:
26.10.2026.
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