Vascular Access Site and Outcomes Among 26,807 Chronic Total Coronary Occlusion Angioplasty Cases From the British Cardiovascular Interventions Society National Database

JACC Cardiovasc Interv. 2017 Apr 10;10(7):635-644. doi: 10.1016/j.jcin.2016.11.055.

Abstract

Objectives: The aim of this study was to assess, using a national percutaneous coronary intervention (PCI) database, access-site choice and outcomes after chronic total occlusion (CTO) PCI.

Background: Given the influence of access site on outcomes, the use of radial access in CTO PCI warrants further investigation.

Methods: Data were analyzed from the British Cardiovascular Intervention Society dataset of 26,807 elective CTO PCI procedures performed in England and Wales between 2006 and 2013. Multivariate logistic regression was used to identify predictors of access-site choice and its association with outcomes.

Results: There was a significant decrease in femoral artery (FA) access from 84.6% in 2006 to 57.9% in 2013. Procedural factors associated with FA access included dual access (odds ratio [OR]: 3.89; 95% confidence interval [CI]: 3.45 to 4.32), CrossBoss/Stingray (OR: 1.87; 95% CI: 1.43 to 2.12), intravascular ultrasound (OR: 1.32; 95% CI: 1.21 to 1.53), and microcatheter use (OR: 1.18; 95% CI: 1.03 to 1.39). There was an association between FA access and the number of CTO devices used (p = 0.001 for trend). Access-site complications (1.5% vs. 0.5%; p < 0.001), periprocedural myocardial infarction (0.5% vs. 0.2%; p = 0.037), major bleeding (0.8% vs. 0.2%, p < 0.001), transfusion (0.4% vs. 0%; p < 0.001), and 30-day death (0.6% vs. 0.1%; p = 0.002) were more frequent in patients undergoing CTO PCI using FA access. An access-site complication during CTO PCI was associated with significant increases in transfusion (8.0% vs. 0.1%; p < 0.001), procedural coronary complication (17.3% vs. 5.8%; p < 0.0001), major bleeding (8.4% vs. 0.3%; p < 0.001), and mortality at all time points.

Conclusions: FA access remains predominant during CTO PCI, with case complexity and device size associated with its use. Access-site complications were more frequent with FA use and strongly correlated with adverse outcomes.

Keywords: access choice; chronic total occlusion; complications; national database; percutaneous coronary intervention.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Angina, Stable / diagnostic imaging
  • Angina, Stable / mortality
  • Angina, Stable / therapy*
  • Angioplasty* / adverse effects
  • Angioplasty* / instrumentation
  • Angioplasty* / methods
  • Angioplasty* / mortality
  • Blood Transfusion
  • Cardiac Catheters
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / instrumentation
  • Catheterization, Peripheral / methods*
  • Catheterization, Peripheral / mortality
  • Chi-Square Distribution
  • Chronic Disease
  • Coronary Occlusion / diagnostic imaging
  • Coronary Occlusion / mortality
  • Coronary Occlusion / therapy*
  • Databases, Factual
  • England
  • Female
  • Femoral Artery* / diagnostic imaging
  • Hemorrhage / etiology
  • Hemorrhage / therapy
  • Humans
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Miniaturization
  • Multivariate Analysis
  • Myocardial Infarction / etiology
  • Odds Ratio
  • Proportional Hazards Models
  • Punctures
  • Radial Artery* / diagnostic imaging
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional
  • Wales