Kinnaird, T, Anderson, R, Ossei-Gerning, N, Gallagher, S, Large, A, Strange, J, Ludman, P, de Belder, M, Nolan, J, Hildick Smith, D and Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 (2017) Vascular access site and outcomes among 26,807 chronic total coronary occlusion angioplasty cases from the British Cardiovascular Interventions Society National database. JACC: Cardiovascular Interventions, 10 (7). pp. 635-644.

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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.

Item Type: Article
Additional Information: This is the author accepted manuscript of a paper to be published by JACC: Cardiovascular Interventions.
Uncontrolled Keywords: access choice, chronic total occlusion, complications, national database, percutaneous coronary intervention
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 01 Dec 2016 09:45
Last Modified: 20 Mar 2019 14:30
URI: http://eprints.keele.ac.uk/id/eprint/2555

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