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Conventional vascular access site approach versus fully trans‐wrist approach for chronic total occlusion percutaneous coronary intervention: a multicenter registry
Author(s) -
Poletti Enrico,
Azzalini Lorenzo,
Ayoub Mohamed,
Ojeda Soledad,
Zivelonghi Carlo,
La Manna Alessio,
Bellini Barbara,
Lostalo Adrián,
Luque Aurora,
Venuti Giuseppe,
Montorfano Matteo,
Agostoni Pierfrancesco,
Pan Manuel,
Carlino Mauro,
Mashayekhi Kambis
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28513
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , clinical endpoint , surgery , cardiology , incidence (geometry) , vascular closure device , diabetes mellitus , percutaneous , myocardial infarction , randomized controlled trial , physics , optics , endocrinology
Objectives To evaluate the incidence of vascular complication and major bleeding in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with a fully trans‐wrist access (TWA) approach versus a conventional approach based on trans‐femoral access (TFA). Background TFA is the preferred vascular access in CTO PCI, but it has been associated with a non‐negligible risk of complications. Methods This retrospective registry included all patients undergoing CTO PCI at five institutions between July 2011 and October 2018. Patients were divided into two groups: Conventional (patients treated with at least one TFA) and Fully TWA (subjects exclusively treated with one or two TWA). The primary safety endpoint was a composite of vascular complications and major bleeding. The primary efficacy endpoint was procedural success. Results We included 1,900 patients (Conventional n = 1,496 and Fully TWA n = 404). Conventional patients showed higher occlusion complexity (J‐CTO score 2.1 ± 1.2 vs. 1.5 ± 1.1, p < .001). Procedural success showed no significant difference between both groups (85.7 vs. 83.0%, p = .17). The primary safety endpoint occurred more frequently in the Conventional group (10.3 vs. 4.5%, p < .001), driven by vascular complications (9.4 vs. 3.7%, p < .001). On multivariate analysis, not using a Fully TWA approach was an independent predictor of the study endpoint, after adjusting for age, sex, diabetes, body mass index, chronic kidney disease, prior coronary artery bypass graft, and J‐CTO score. Conclusions Embracing a Fully TWA approach for CTO PCI might be associated with lower incidence of a composite endpoint of vascular complications and major bleeding, compared with a Conventional approach.