British Study Analyzes Outcomes of CTO-PCI Procedures Using Enabling Strategies
October 30, 2018—Online in Circulation: Cardiovascular Interventions, Tim Kinnaird, MD, et al published findings from an analysis of 28,050 cases from the British Cardiovascular Intervention Society database. Using the dataset, the analysis examined procedural success and outcomes with the increasing use of enabling strategies (ESs) during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). In the analysis, ESs were defined as intravascular ultrasound, rotational/laser atherectomy, dual arterial access, and use of microcatheters, penetration catheters, or CrossBoss (Boston Scientific Corporation). Procedures were categorized by the number of ESs used.
As summarized in the Circulation: Cardiovascular Interventions, data were analyzed on all elective CTO-PCI procedures performed in England and Wales between 2006 and 2014. The investigators used multivariable logistic regression to identify predictors of procedural success.
The investigators reported that there were significant temporal increases in ES use during 28,050 CTO-PCIs. 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 < .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 < .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.
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, concluded the investigators in Circulation: Cardiovascular Interventions.