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Five-year report from the Polish national registry on percutaneous coronary interventions with a focus on coronary
Rafał Januszek1,2, Leszek Bryniarski1,3, Zbigniew Siudak4
1Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
Insights
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) leads to more complications, especially coronary artery perforations (CAPs). CTO PCI is a significant predictor of increased CAP rates in patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) face elevated risks of periprocedural complications.
- Coronary artery perforations (CAPs) are a significant concern in PCI procedures, particularly in complex cases like CTOs.
Purpose of the Study:
- To determine the incidence of periprocedural complications, with a focus on CAPs, in patients undergoing PCI for CTOs.
- To identify predictors of periprocedural complications and CAPs in the context of CTO PCI.
Main Methods:
- Analysis of a nationwide registry (ORPKI) data from 535,853 patients treated with PCI between 2014 and 2018.
- Comparison of 12,572 patients treated with CTO PCI versus a non-CTO PCI group, utilizing propensity score matching (PSM).
- Application of multifactorial mixed regression models to identify predictors of complications and CAPs.
Main Results:
- CTO PCI was associated with significantly higher rates of overall periprocedural complications (2.75% vs. 1.93%) and CAPs (0.72% vs. 0.16%) compared to non-CTO PCI.
- PCI within CTOs independently predicted a higher CAP rate (OR = 2.18) in the overall PCI cohort.
- After PSM, CTO PCI remained a significant predictor of CAPs (OR = 1.89).
Conclusions:
- The frequency of periprocedural complications and CAPs remained consistent over the study period.
- CTO PCI is a confirmed predictor of an increased rate of coronary artery perforations in patients undergoing PCI.
Introduction:
Patients treated within chronic total occlusions (CTO) using percutaneous coronary intervention (PCI) are at increased risk of periprocedural complications.
Aim:
To assess the frequency of periprocedural complications with particular emphasis on coronary artery perforations (CAPs) among patients treated with PCIs stratified according to CTOs and their predictors.
Material And Methods:
Based on a nationwide registry (ORPKI), we analysed 535,853 patients treated with PCI between 2014 and 2018. The study included 12,572 (2.34%) patients treated with CTO PCI. We compared CTO PCI to a non-CTO PCI group before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of periprocedural complications and CAPs which occurred within the catheterization laboratory.
Results:
Frequencies of all periprocedural complications (2.75% vs. 1.93%, p < 0.001) and CAP (0.72% vs. 0.16%, p < 0.001) were significantly higher in the CTO PCI group. Multifactorial regression analysis performed in the all-comers group of patients treated with PCI showed that PCI within CTO was related to a higher CAP rate (odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.68-2.82, p < 0.001). After PSM, we extracted 5,652 patients treated within CTO and 5,652 patients with non-CTO PCI. CTO PCI was also related to a higher frequency of CAPs (OR = 1.89; 95% CI: 1.11-3.31, p = 0.01).
Conclusions:
The frequency of periprocedural complications and CAPs remained stable during the assessed period of time. CTO PCI was confirmed to be among the predictors of increased CAP rate in the overall group of patients treated within CTO.
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