Published online Apr 26, 2019. doi: 10.12998/wjcc.v7.i8.928
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
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.
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.
To investigate whether the use of Fielder XT guidewire increases the final procedural success of CTO-PCI via the anterograde approach.
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.
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].
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.
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.