25 Vascular access site and outcomes among 26,807 CTO-PCI cases from the national angioplasty audit

Kinnaird, Tim; Anderson, Richard; Gallagher, Sean; Large, Adrian; Strange, Julian; Ludman, Peter; de Belder, Mark; Nolan, James; Hildick-Smith, David; Mamas, Mamas

Abstract

Background Use of radial access in chronic total occlusion percutaneous coronary intervention (CTO-PCI) warrants further investigation. Using the BCIS PCI database, access site choice and outcomes after CTO-PCI were assessed.

Methods Data were analysed on 26 807 elective CTO-PCI procedures performed 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 decrease in femoral artery (FA) utilisation from 84.6% in 2006 to 57.9% in 2013. Procedural factors associated with FA access included dual access (OR 4.01, 3.63–4.44), Crossboss/Stingray (2.06, 1.55–2.75), IVUS (1.26, 1.12–1.40), and micro-catheter use (1.15, 1.06–1.25). There was an association between FA access and the number of CTO devices used (p=0.001 for trend). An access site complication (1.5 vs 0.5%, p<0.001), major bleeding (0.8 vs 0.2%, p=0.007), transfusion (0.4 vs 0%, p<0.001) and 30 day death (0.7 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<0.001), 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.

Citation

Kinnaird, T., Anderson, R., Gallagher, S., Large, A., Strange, J., Ludman, P., …Mamas, M. (2017). 25 Vascular access site and outcomes among 26,807 CTO-PCI cases from the national angioplasty audit. Heart, 103(S7), https://doi.org/10.1136/heartjnl-2017-BCIS.25

• Journal Article Type: Conference Paper
• Conference Name: British Cardiovascular Intervention Society - January 2017
• Conference Location: London, UK
• Online Publication Date: Nov 27, 2017
• Publication Date: Nov 27, 2017
• Deposit Date: Nov 30, 2023
• Journal: Heart
• Print ISSN: 1355-6037
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 103
• Issue: S7
• DOI: https://doi.org/10.1136/heartjnl-2017-BCIS.25
• Publisher URL: https://heart.bmj.com/content/103/Suppl_7/A11.2