Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2019; 7(8): 928-939
Published online Apr 26, 2019. doi: 10.12998/wjcc.v7.i8.928
Optimal use of fielder XT guidewire enhances the success rate of chronic total occlusion percutaneous coronary intervention
Qian-Cheng Wang, Hai-Ruo Lin, Yuan Han, Hai Dong, Kai Xu, Shao-Yi Guan, Zhen-Huan Chen, Hui-Xin Hao, Jian-Ping Bin, Yu-Lin Liao, Quan-Min Jing
Qian-Cheng Wang, Hai-Ruo Lin, Yuan Han, Zhen-Huan Chen, Hui-Xin Hao, Jian-Ping Bin, Yu-Lin Liao, Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Qian-Cheng Wang, Hai Dong, Kai Xu, Shao-Yi Guan, Quan-Min Jing, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China
Author contributions: All authors helped to perform the study; Jing QM, Liao YL and Wang QC contributed to study conception and design; Jing QM, Wang QC, Dong H, Xu K, Guan SY and Han Y contributed to performing the procedures and collecting the data; Bin JP, Lin HR, Chen ZH and Hao HX contributed to interpreting the data and statistical analysis; Wang QC and Liao YL contributed to manuscript writing and made critical revision on the manuscript; All authors reviewed the manuscript and completed final approval.
Supported by the National Natural Science Foundation of China, No. 81570464 and No. 81770271; Special Fund for the Cultivation of College Students’ Science and Technology Innovation in 2018, No. pdjha0095; and Municipal Planning Projects of Scientific Technology of Guangzhou, No. 201804020083.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the General Hospital of Northern Theater Command.
Informed consent statement: Patients were not required to provide informed consent to participate in this study because the analyses used anonymous clinical data that were obtained after each patient had agreed to treatment based written consent.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu-Lin Liao, PhD, Professor, Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong Province, China. liao18@msn.com
Telephone: +86-20-62786294 Fax: +86-20-62786294
Received: January 30, 2019
Peer-review started: January 31, 2019
First decision: March 10, 2019
Revised: March 22, 2019
Accepted: April 9, 2019
Article in press: April 9, 2019
Published online: April 26, 2019
Processing time: 87 Days and 1.5 Hours
ARTICLE HIGHLIGHTS
Research background

Chronic total occlusion (CTO) is found in 18%-31% of patients who undergo coronary angiography. Successful recanalization of CTOs has been shown to be associated with reduced recurrent angina pectoris rates and increased long-term survival. Although the success rate of CTO percutaneous coronary intervention (CTO-PCI) has improved, CTO-PCI remains technically challenging. The Fielder XT guidewire was designed for CTO lesions. To validate whether the use of the guidewire increases the success rate, we compared the results of CTO-PCI with or without the guidewire. We hypothesized that the use of Fielder XT guidewire can increase the success rate of CTO-PCI.

Research motivation

Although experience and the introduction of new devices have improved the success rates of PCI, CTO-PCI is still technically challenging. We thus wanted to validate whether the use of Fielder XT guidewire increases the success rate of CTO-PCI.

Research objectives

To investigate whether the use of Fielder XT guidewire increases the final procedural success of CTO-PCI via the anterograde approach.

Research methods

Between January 2013 and December 2015, a retrospective study was conducted on 1230 consecutive patients with CTO who received PCI via the anterograde approach at the General Hospital of Northern Theater Command. The patients were divided into an XT Group (n = 686) and a no-XT Group (n = 544) depending on whether Fielder XT guidewire was used. Both groups were compared for clinical parameters, lesion-related characteristics, procedural outcomes and in-hospital complications. The data were statistically analyzed using a Pearson’s χ2 test for categorical variables, and a Students’ t test was used to compare the quantitative data. Significant independent factors and risk ratios with a 95% confidence interval (CI) were assessed by multivariate logistic regression analysis.

Research results

In total, 1230 patients were recruited; 75.4% of the patients were male, and 55.8% of the patients were in the XT group. The overall success rate was 83.9%, with 87.8% in the XT group. Based on multivariate logistic regression analysis, factors positively associated with procedural success were the use of Fielder XT guidewire (P = 0.005, 95%CI: 1.172-2.380) and systolic blood pressure (P = 0.011, 95%CI: 1.003-1.022), while factors negatively associated with procedural success were blunt stump (P = 0.013, 95%CI: 1.341-11.862), male sex (P = 0.016, 95%CI: 0.363-0.902), NYHA class (P = 0.035, 95%CI: 0.553-0.979), contrast amount (P = 0.018, 95%CI: 0.983-0.998) and occlusion time (P = 0.009, 95%CI: 0.994-0.999). No significant differences were found between the XT group and the no-XT group with respect to clinical parameters, lesion-related characteristics, coronary artery rupture [3 (0.4%) vs 8 (1.5%), P = 0.056], in-hospital death [2 (0.3%) vs 6 (1.1%), P = 0.079] or in-hospital target lesion revascularization [3 (0.4%) vs 7 (1.3%), P < 0.099]. However, there were significant differences between the groups with respect to success rate [602 (87.8%) vs 430 (79.0%), P < 0.001], procedure time [(74 ± 23) vs (83 ± 21), P < 0.001], stent length [(32.0 ± 15.8) vs (37.3 ± 17.6), P < 0.001], contrast amount [(148 ± 46) vs (166 ± 43), P < 0.001], post-PCI myocardial infarction [43 (6.3%) vs 59 (10.8%), P = 0.004], major adverse cardiovascular event [44 (6.4%) vs 57 (10.7%), P = 0.007], side branch loss [31 (4.5%) vs 44 (8.1%), P = 0.009], contrast-induced nephropathy [29 (4.2%) vs 40 (7.4%), P = 0.018] and no reflow [8 (1.2%) vs 14 (2.9%), P = 0.034].

Research conclusions

The use of Fielder XT guidewire shortens the procedure and increases the success rate of CTO-PCI, and is also associated with reduced complication rates.

Research perspectives

Larger multicenter studies are required to better understand the relationship between the use of Fielder XT series (such as Fielder XT, Fielder XT-R and Fielder XT-A) guidewires and the procedural success of CTO-PCI via anterograde, retrograde, or hybrid approaches.