Vascular Access Site and Outcomes Studied in PCI Procedures of CTO Patients From British Database
April 17, 2017—Tim Kinnaird, MD, et al published findings from a study that used a national percutaneous coronary intervention (PCI) database to assess access-site choice and outcomes after chronic total occlusion (CTO) PCI. The study is available online ahead of print in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.
The investigators analyzed data 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.
As summarized in JACC: Cardiovascular Interventions, there was a significant decrease in femoral-access procedures from 84.6% in 2006 to 57.9% in 2013. Procedural factors associated with femoral access included dual access (odds ratio [OR], 3.89; 95% confidence interval [CI], 3.45 to 4.32), CrossBoss/Stingray (Boston Scientific Corporation; 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).
The investigators reported that there was an association between femoral artery access and the number of CTO devices used (P = .001 for trend). Access-site complications (1.5% vs 0.5%; P < .001), periprocedural myocardial infarction (0.5% vs 0.2%; P = .037), major bleeding (0.8% vs 0.2%; P < .001), transfusion (0.4% vs 0%; P < .001), and 30-day death (0.6% vs 0.1%; P = .002) were more frequent in patients undergoing CTO PCI using femoral artery access versus radial artery access. An access-site complication during CTO PCI was associated with significant increases in transfusion (8% vs 0.1%; P < .001), procedural coronary complication (17.3% vs. 5.8%; P < .0001), major bleeding (8.4% vs 0.3%; P < .001), and mortality at all time points for femoral versus radial artery access.
The investigators concluded the femoral artery access remains predominant during CTO PCI, with case complexity and device size associated with its use. In addition, access-site complications were more frequent with femoral artery use and strongly correlated with adverse outcomes, noted the investigators in JACC: Cardiovascular Interventions.