Vascular Access Site and Outcomes Among 26,807 Chronic Total Coronary Occlusion Angioplasty Cases From the British Cardiovascular Interventions Society National Database
| Autor: | Mamas A. Mamas, David Hildick-Smith, Julian Strange, Tim Kinnaird, Adrian Large, Richard Anderson, Peter Ludman, James Nolan, Mark A. de Belder, Nick Ossei-Gerning, Sean Gallagher |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Time Factors Databases Factual medicine.medical_treatment Myocardial Infarction 030204 cardiovascular system & hematology Logistic regression Cardiac Catheters 0302 clinical medicine Risk Factors Intravascular ultrasound Odds Ratio 030212 general & internal medicine medicine.diagnostic_test Middle Aged Femoral Artery Treatment Outcome England Radial Artery Female Cardiology and Cardiovascular Medicine medicine.medical_specialty Hemorrhage Punctures 03 medical and health sciences Angioplasty Internal medicine Catheterization Peripheral medicine Humans Blood Transfusion Angina Stable Ultrasonography Interventional Aged Proportional Hazards Models Chi-Square Distribution Miniaturization Wales business.industry Percutaneous coronary intervention Odds ratio R1 Confidence interval Surgery Logistic Models Coronary Occlusion Coronary occlusion Chronic Disease Multivariate Analysis Conventional PCI Linear Models business |
| Zdroj: | JACC: Cardiovascular Interventions. 10:635-644 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2016.11.055 |
| Popis: | Objectives\ud 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.\ud \ud Background\ud Given the influence of access site on outcomes, the use of radial access in CTO PCI warrants further investigation.\ud \ud Methods\ud 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.\ud \ud Results\ud 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.\ud \ud Conclusions\ud 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. |
| Databáze: | OpenAIRE |
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