TY - JOUR
T1 - Contrast Utilization during Chronic Total Occlusion Percutaneous Coronary Intervention
T2 - Insights from a Contemporary Multicenter Registry
AU - Christakopoulos, Georgios E.
AU - Karmpaliotis, Dimitri
AU - Alaswad, Khaldoon
AU - Yeh, Robert W.
AU - Jaffer, Farouc A.
AU - Wyman, R. Michael
AU - Lombardi, William
AU - Grantham, J. Aaron
AU - Kandzari, David A.
AU - Lembo, Nicholas
AU - Moses, Jeffrey W.
AU - Kirtane, Ajay
AU - Parikh, Manish
AU - Green, Philip
AU - Finn, Matthew
AU - Garcia, Santiago
AU - Doing, Anthony
AU - Patel, Mitul
AU - Bahadorani, John
AU - Christopoulos, Georgios
AU - Karatasakis, Aris
AU - Thompson, Craig A.
AU - Banerjee, Subhash
AU - Brilakis, Emmanouil S.
PY - 2016/7
Y1 - 2016/7
N2 - BACKGROUND: Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy. METHODS: We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers. RESULTS: Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P≤.01), smoking (P≤.01), prior coronary artery bypass graft surgery (P≤.04), moderate or severe calcification (P≤.01), moderate or severe tortuosity (P≤.04), proximal cap ambiguity (P≤.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P≤.01), occlusion length (P<.001), higher J-CTO score (P≤.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P≤.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P≤.01) and in-stent restenosis (P≤.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P≤.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P≤.01), 8 Fr guide catheters (P≤.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P≤.02), larger target vessel diameter (P≤.03), and presence of interventional collaterals (P<.001) were associated with lower contrast utilization. CONCLUSIONS: Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.
AB - BACKGROUND: Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy. METHODS: We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers. RESULTS: Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P≤.01), smoking (P≤.01), prior coronary artery bypass graft surgery (P≤.04), moderate or severe calcification (P≤.01), moderate or severe tortuosity (P≤.04), proximal cap ambiguity (P≤.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P≤.01), occlusion length (P<.001), higher J-CTO score (P≤.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P≤.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P≤.01) and in-stent restenosis (P≤.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P≤.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P≤.01), 8 Fr guide catheters (P≤.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P≤.02), larger target vessel diameter (P≤.03), and presence of interventional collaterals (P<.001) were associated with lower contrast utilization. CONCLUSIONS: Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.
KW - air kerma
KW - chronic total occlusion
KW - complications
KW - contrast volume
KW - fluoroscopy
KW - percutaneous coronary intervention
KW - radiation
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M3 - Article
C2 - 27342206
AN - SCOPUS:84976353420
SN - 1042-3931
VL - 28
SP - 288
EP - 294
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
IS - 7
ER -