title: Vascular Access Site and Outcomes Among 26,807 Chronic Total Coronary Occlusion Angioplasty Cases From the British Cardiovascular Interventions Society National Database.
abstract: 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.
  
  
  
  Given the influence of access site on outcomes, the use of radial access in CTO PCI warrants further investigation.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom. Electronic address: tim.kinnaird2@wales.nhs.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Anderson
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Ossei-Gerning
authors.affiliation: Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: Gallagher
authors.affiliation: Department of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Large
authors.affiliation: Department of Cardiology, Bristol Royal Infirmary, Bristol, United Kingdom.
authors.forename: Julian
authors.initials: J
authors.lastname: Strange
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: de Belder
authors.affiliation: Department of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.affiliation: Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.affiliation: Department of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
authors.forename: Mamas
authors.initials: M
authors.lastname: Mamas
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D001803:Blood Transfusion; D062906:Cardiac Catheters; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D004739:England; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014852:Wales
keywords: access choice; chronic total occlusion; complications; national database; percutaneous coronary intervention