Procedural and Prognostic Implications of Guide Extension Catheter Use During Percutaneous Coronary Intervention: A...

Guide extension catheters (GECs) have become an essential adjunctive tool in complex percutaneous coronary interventions (PCIs). GECs provide additional catheter support and stability, enhancing device deliverability.

Our study aims to evaluate the technical and prognostic significance of the use of GECs in complex PCI.

Our study included 23,299 PCI cases performed in a large tertiary center between 2010 and 2023. We assessed rates of procedural success with GEC. The primary clinical endpoint was all cause-mortality. Other clinical endpoints included major adverse cardiac events (MACE) during follow-up. Cox regression, multivariate analysis, and propensity score matching were used to compare GEC and non-GEC PCI cases.

Of the 23,299 PCI cases in our study, 532 patients (2%) were treated utilizing GECs. The median age was 66 [IQR 58-75], and 88% were males. Successful PCI was performed in 96.2% of the total cohort, with similar rates in the GEC and non-GEC group (94.9% vs. 96.2%, p = 0.144). GEC was used more often in calcified, bifurcation, and unprotected left main lesions. Patients requiring the use of GEC had higher long-term mortality rates (HR 1.86, 95% CI 1.54-2.23, p < 0.001) and MACE events (HR 1.26, 95% CI 1.07-1.47, p = 0.004). Multivariate adjustments, sensitivity analysis of complex-PCI cases, and a propensity score-matched model showed similar results. A landmark analysis showed no significant difference in 30-day mortality but divergence of the survival curves after 30 days with increased mortality among the GEC cohort.

Our study showed that patients who required GEC during PCI were successfully treated in the vast majority of cases, with similar short-term results. However, the use of GEC is associated with a worse long-term prognosis, reflecting a surrogate for sicker patients and procedural complexity, thus requiring careful follow-up.