Author + information
- Received November 22, 2016
- Accepted November 30, 2016
- Published online April 3, 2017.
- Tim Kinnaird, MDa,∗ (, )
- Richard Anderson, MDa,
- Nick Ossei-Gerning, MDa,
- Sean Gallagher, MDa,
- Adrian Large, MDb,
- Julian Strange, MDc,
- Peter Ludman, MDd,
- Mark de Belder, MDe,
- James Nolan, MDb,f,
- David Hildick-Smith, MDg and
- Mamas Mamas, PhDb,f
- aDepartment of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
- bDepartment of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom
- cDepartment of Cardiology, Bristol Royal Infirmary, Bristol, United Kingdom
- dDepartment of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
- eDepartment of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom
- fKeele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom
- gDepartment of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
- ↵∗Address for correspondence:
Dr. Tim Kinnaird, Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
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.
- access choice
- chronic total occlusion
- national database
- percutaneous coronary intervention
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 22, 2016.
- Accepted November 30, 2016.
- 2017 American College of Cardiology Foundation