Predictors of major adverse cardiac events, high radiation
exposure, and contrast use in percutaneous coronary
interventions for calcified lesions

Christos N. Bousis; Evaggelia Kalampoki; Anna Kotsia; Pavlos Karanikis; Athanasios Kosovitsas; Eleni Tzima; Vasiliki Beli; Evgenia Pappa

doi:10.5114/aic.2026.160014

Abstract

1/2026 vol. 22

Original paper

Predictors of major adverse cardiac events, high radiation exposure, and contrast use in percutaneous coronary interventions for calcified lesions

Christos N. Bousis ¹

,

Evaggelia Kalampoki ²

,

Anna Kotsia ²

,

Pavlos Karanikis ²

,

Athanasios Kosovitsas ²

,

Eleni Tzima ²

,

Vasiliki Beli ²

,

Evgenia Pappa ²

Medical Physics Department, General Hospital of Ioannina “CHATZIKOSTA”, Ioannina, Greece
Cardiology Clinic, Haemodynamics Department, General Hospital of Ioannina “CHATZIKOSTA”, Ioannina, Greece

Adv Interv Cardiol 2026; 22, 1 (83): 8–20

DOI: https://doi.org/10.5114/aic.2026.160014

Online publish date: 2026/03/09

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AMA

Bousis C, Kalampoki E, Kotsia A, et al. Predictors of major adverse cardiac events, high radiation exposure, and contrast use in percutaneous coronary interventions for calcified lesions. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2026;22(1):8-20. doi:10.5114/aic.2026.160014.

APA

Bousis, C., Kalampoki, E., Kotsia, A., Karanikis, P., Kosovitsas, A., & Tzima, E. et al. (2026). Predictors of major adverse cardiac events, high radiation exposure, and contrast use in percutaneous coronary interventions for calcified lesions. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 22(1), 8-20. https://doi.org/10.5114/aic.2026.160014

Chicago

Bousis, Christos N., Evaggelia Kalampoki, Anna Kotsia, Pavlos Karanikis, Athanasios Kosovitsas, Eleni Tzima, and Vasiliki Beli et al. 2026. "Predictors of major adverse cardiac events, high radiation exposure, and contrast use in percutaneous coronary interventions for calcified lesions". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 22 (1): 8-20. doi:10.5114/aic.2026.160014.

Harvard

Bousis, C., Kalampoki, E., Kotsia, A., Karanikis, P., Kosovitsas, A., Tzima, E., Beli, V., and Pappa, E. (2026). Predictors of major adverse cardiac events, high radiation exposure, and contrast use in percutaneous coronary interventions for calcified lesions. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 22(1), pp.8-20. https://doi.org/10.5114/aic.2026.160014

MLA

Bousis, Christos N. et al. "Predictors of major adverse cardiac events, high radiation exposure, and contrast use in percutaneous coronary interventions for calcified lesions." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 22, no. 1, 2026, pp. 8-20. doi:10.5114/aic.2026.160014.

Vancouver

Bousis C, Kalampoki E, Kotsia A, Karanikis P, Kosovitsas A, Tzima E et al. Predictors of major adverse cardiac events, high radiation exposure, and contrast use in percutaneous coronary interventions for calcified lesions. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2026;22(1):8-20. doi:10.5114/aic.2026.160014.

Introduction

Percutaneous coronary intervention (PCI) for calcified lesions poses risks of major adverse cardiac events (MACE), increased radiation exposure, and contrast use for patients.

Aim

To analyze radiation exposure and contrast use during PCI for calcified lesions and identify key predictors of MACE.

Material and methods

A cohort of 281 patients undergoing PCI for calcified lesions between March 2018 and April 2025 was studied. Multiple linear regression was used to analyze dose–area product (DAP) and contrast, while binary logistic regression identified factors associated with high DAP (≥ 500 Gy·cm²) or low DAP (< 500 Gy·cm²) and MACE.

Results

DAP was primarily affected by operator (fold change = 0.55; 95% CI: 0.49–0.62; p < 0.001). Male sex and ad-hoc (vs. elective) PCI resulted in elevated DAP (fold change = 1.22; 95% CI: 1.10–1.35; p < 0.001 and fold change = 1.14; 95% CI: 1.03–1.26; p = 0.01, respectively). Higher contrast use correlated with more balloons deployed (fold change = 1.1; 95% CI: 1.0–1.2; p ≤ 0.03) and longer irradiation time (fold change = 1.02; 95% CI: 1.01–1.03; p < 0.001). High DAP was mainly predicted by procedures on chronic total occlusions (OR = 14.61; 95% CI: 4.21–50.60; p < 0.001) and by a greater number of PCIs (OR = 12.47; 95% CI: 5.35–29.06; p < 0.001). MACE risk increased with the presence of chronic kidney disease (OR = 5.89; 95% CI: 2.09–16.62; p < 0.001 at 6 months and OR = 7.22; 95% CI: 2.80–18.62; p < 0.001 at 1 year); severe (vs. mild or moderate) calcifications further amplified 1-year MACE risk (OR = 2.55; 95% CI: 1.01–6.43; p = 0.046).

Conclusions

Managing factors related to operator, procedural complexity, calcification severity, and patient comorbidities is essential to reduce radiation and contrast exposure, as well as MACE, during interventions on calcified lesions.

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Keywords

analysis, contrast, major adverse cardiac events, percutaneous coronary interventions, calcified lesions, dose–area product

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