Skip to main content

Research Repository

Advanced Search

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

Kinnaird , Tim; Cockburn, James; Sirker, Alexander; Ludman, Peter; de Belder, Mark; Smith, Elliot; Anderson, Richard; Strange, Julian; Mamas, Mamas; Hildick-Smith, David

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 Thumbnail


Authors

Tim Kinnaird

James Cockburn

Alexander Sirker

Peter Ludman

Mark de Belder

Elliot Smith

Richard Anderson

Julian Strange

David Hildick-Smith



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.

Acceptance Date Aug 9, 2018
Publication Date Oct 12, 2018
Publicly Available Date Mar 29, 2024
Journal Circulation: Cardiovascular Interventions
Print ISSN 1941-7640
Publisher American Heart Association
DOI https://doi.org/10.1161/CIRCINTERVENTIONS.118.006436
Keywords complications, hospital, mortality, percutaneous coronary intervention
Publisher URL http://doi.org/10.1161/CIRCINTERVENTIONS.118.006436

Files







You might also like



Downloadable Citations