Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion
Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of techn...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/7/1486 |
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| author | Peter Tajti Mohamed Ayoub Thomas Nuehrenberg Miroslaw Ferenc Michael Behnes Heinz Joachim Buettner Franz-Josef Neumann Kambis Mashayekhi |
| author_facet | Peter Tajti Mohamed Ayoub Thomas Nuehrenberg Miroslaw Ferenc Michael Behnes Heinz Joachim Buettner Franz-Josef Neumann Kambis Mashayekhi |
| author_sort | Peter Tajti |
| collection | DOAJ |
| description | Background: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, <i>n</i> = 2720) and PCI for non-CTO (<i>n</i> = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both <i>p</i> < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, <i>p</i> < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, <i>p</i> < 0.001) in CTO PCI. The optimal cut-point for prediction of PF was 21.1 min in non-CTO PCI (procedural success in 98.4% versus 95.3%, adjusted OR for PF 2.79 (CI 95% 1.93–4.04), <i>p</i> < 0.001) and 41 min in CTO PCI (procedural success in 92.3% versus 83.8%, adjusted OR for PF 2.18 (CI 95% 1.64–2.94), <i>p</i> < 0.001). In CTO PCI, the increase in PF with FT was largely driven by technical failure (adjusted OR 2.25 (CI 95% 1.65–3.10), <i>p</i> < 0.001), whereas in non-CTO PCI, it was driven by major complications (adjusted OR 2.94 (CI 95% 1.93–4.53), <i>p</i> < 0.001). Conclusions: Prolonged FT is strongly associated with procedural failure in both non-CTO and CTO PCI. In CTO PCI, this relation is shifted towards longer FT. The mechanisms of procedural failure differ between CTO and non-CTO PCI. |
| first_indexed | 2024-03-10T12:37:32Z |
| format | Article |
| id | doaj.art-3b558d9b514445ce8dbce91f4cdaf44f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T12:37:32Z |
| publishDate | 2021-04-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-3b558d9b514445ce8dbce91f4cdaf44f2023-11-21T14:06:29ZengMDPI AGJournal of Clinical Medicine2077-03832021-04-01107148610.3390/jcm10071486Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total OcclusionPeter Tajti0Mohamed Ayoub1Thomas Nuehrenberg2Miroslaw Ferenc3Michael Behnes4Heinz Joachim Buettner5Franz-Josef Neumann6Kambis Mashayekhi7Department of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, GermanyDepartment of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, GermanyDepartment of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, GermanyDepartment of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, GermanyFirst Department of Medicine, University Medical Center Mannheim, 68167 Mannheim, GermanyDepartment of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, GermanyDepartment of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, GermanyDepartment of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, GermanyBackground: In percutaneous coronary interventions (PCI), the impact of prolonged fluoroscopy time (FT) on procedural outcomes is poorly studied. Methods and Results: We analyzed the outcomes of 12,538 consecutive elective PCIs. The primary endpoint was procedure failure (PF), the composite of technical failure, and adverse in-hospital events including all-cause death, myocardial infarction, stroke, and target vessel revascularization (MACCE), as well as pericardial tamponade. We stratified the procedures as PCI for chronic total occlusion (CTO, <i>n</i> = 2720) and PCI for non-CTO (<i>n</i> = 9818). Logistic regression demonstrated a significant association between fluoroscopy time and procedural failure with a significant interaction with PCI type (both <i>p</i> < 0.001). The odds ratios (OR) of procedural failure for a 10-min increment in FT were 1.15 (confidence interval (CI) 95% 1.12–1.18, <i>p</i> < 0.001) in non-CTO PCI and 1.05 (CI 95% 1.03–1.06, <i>p</i> < 0.001) in CTO PCI. The optimal cut-point for prediction of PF was 21.1 min in non-CTO PCI (procedural success in 98.4% versus 95.3%, adjusted OR for PF 2.79 (CI 95% 1.93–4.04), <i>p</i> < 0.001) and 41 min in CTO PCI (procedural success in 92.3% versus 83.8%, adjusted OR for PF 2.18 (CI 95% 1.64–2.94), <i>p</i> < 0.001). In CTO PCI, the increase in PF with FT was largely driven by technical failure (adjusted OR 2.25 (CI 95% 1.65–3.10), <i>p</i> < 0.001), whereas in non-CTO PCI, it was driven by major complications (adjusted OR 2.94 (CI 95% 1.93–4.53), <i>p</i> < 0.001). Conclusions: Prolonged FT is strongly associated with procedural failure in both non-CTO and CTO PCI. In CTO PCI, this relation is shifted towards longer FT. The mechanisms of procedural failure differ between CTO and non-CTO PCI.https://www.mdpi.com/2077-0383/10/7/1486complex coronary artery diseasechronic total occlusionoutcomespercutaneous coronary intervention |
| spellingShingle | Peter Tajti Mohamed Ayoub Thomas Nuehrenberg Miroslaw Ferenc Michael Behnes Heinz Joachim Buettner Franz-Josef Neumann Kambis Mashayekhi Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion Journal of Clinical Medicine complex coronary artery disease chronic total occlusion outcomes percutaneous coronary intervention |
| title | Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion |
| title_full | Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion |
| title_fullStr | Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion |
| title_full_unstemmed | Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion |
| title_short | Association of Prolonged Fluoroscopy Time with Procedural Success of Percutaneous Coronary Intervention for Stable Coronary Artery Disease with and without Chronic Total Occlusion |
| title_sort | association of prolonged fluoroscopy time with procedural success of percutaneous coronary intervention for stable coronary artery disease with and without chronic total occlusion |
| topic | complex coronary artery disease chronic total occlusion outcomes percutaneous coronary intervention |
| url | https://www.mdpi.com/2077-0383/10/7/1486 |
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