Tim, K, Gallagher, S, Cockburn, J, Sirker, A, Ludman, P, De Belder, M, Elliot, S, Anderson, R, Julian, S, Mamas, MA ORCID: 0000-0001-9241-8890 and David, HS (2018) Procedural success and outcomes with increasing use of enabling strategies for chronic total occlusion intervention: an analysis of 28,050 cases from the British Cardiovascular Intervention Society database. Circulation: Cardiovascular Interventions, 11 (10). ISSN 1941-7632

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Abstract

BACKGROUND
Enabling strategies (ESs) are increasingly used during percutaneous coronary intervention for chronic total occlusive disease (CTO-PCI), enhancing procedural success. Using the British Cardiovascular Society dataset, we examined changes in the use of ESs and procedural/clinical outcomes for CTO-PCI.

METHODS AND RESULTS
ESs were defined as intravascular ultrasound, rotational/laser atherectomy, dual arterial access, use of microcatheters, penetration catheters or CrossBoss, and procedures categorized by number of ESs used. Data were analysed on all elective CTO-PCI procedures performed in England and Wales between 2006 and 2014. Multivariable logistic regression was used to identify predictors of procedural success. During 28050 CTO-PCIs, there were significant temporal increases in ES use. There was a stepwise increase in CTO success with increased ES use, with 83.8% of cases successful where >= 3 ESs were used. Overall, CTO-PCI success rate for the whole cohort increased from 55.4% in 2006 to 66.9% in 2014 (P<0.001), but the greatest increase in procedural success was associated with 3 ES use. In multivariable analysis, any ES use and the number of ESs used were predictive of procedural success. Coronary perforation increased from 1.2% with zero ES use to 4.0% with >= 3 (P<0.001). After adjustment, although arterial complication, in-hospital bleeding, in-hospital mortality, and major adverse cardiovascular or cerebrovascular events remained more likely with ES use, 30-day mortality was not significantly different between groups.

CONCLUSIONS
ES use during CTO-PCI was associated with significant improvements in CTO-PCI success. ES use was associated with increased procedural complications and in-hospital major adverse cardiovascular events, but not with 30-day mortality.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via American Heart Association at http://doi.org/10.1161/CIRCINTERVENTIONS.118.006436 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: complications, hospital, mortality, percutaneous coronary intervention
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 07 Sep 2018 09:09
Last Modified: 01 Nov 2018 09:58
URI: http://eprints.keele.ac.uk/id/eprint/5289

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