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

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.

Citation

Kinnaird, T., Cockburn, J., Sirker, A., Ludman, P., de Belder, M., Smith, E., …Hildick-Smith, D. (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, https://doi.org/10.1161/CIRCINTERVENTIONS.118.006436

• Acceptance Date: Aug 9, 2018
• Publication Date: Oct 12, 2018
• 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