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25 Vascular access site and outcomes among 26,807 CTO-PCI cases from the national angioplasty audit
  1. Tim Kinnaird1,
  2. Richard Anderson1,
  3. Sean Gallagher1,
  4. Adrian Large2,
  5. Julian Strange3,
  6. Peter Ludman4,
  7. Mark de Belder5,
  8. James Nolan2,6,
  9. David Hildick-Smith7,
  10. Mamas Mamas2,6
  1. 1Department of Cardiology, University Hospital of Wales, Cardiff
  2. 2Department of Cardiology, Royal Stoke Hospital, UHNM, Stoke-on-Trent
  3. 3Department of Cardiology, Bristol Royal Infirmary, Bristol
  4. 4Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham
  5. 5Department of Cardiology, The James Cook University Hospital, Middlesbrough
  6. 6Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent
  7. 7Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton


Background Use of radial access in chronic total occlusion percutaneous coronary intervention (CTO-PCI) warrants further investigation. Using the BCIS PCI database, access site choice and outcomes after CTO-PCI were assessed.

Methods Data were analysed on 26 807 elective CTO-PCI procedures performed 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 decrease in femoral artery (FA) utilisation from 84.6% in 2006 to 57.9% in 2013. Procedural factors associated with FA access included dual access (OR 4.01, 3.63–4.44), Crossboss/Stingray (2.06, 1.55–2.75), IVUS (1.26, 1.12–1.40), and micro-catheter use (1.15, 1.06–1.25). There was an association between FA access and the number of CTO devices used (p=0.001 for trend). An access site complication (1.5 vs 0.5%, p<0.001), major bleeding (0.8 vs 0.2%, p=0.007), transfusion (0.4 vs 0%, p<0.001) and 30 day death (0.7 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<0.001), 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.

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