Contrast Utilization During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Abstract

Background: Administration of a large amount of contrast volume during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to contrast-induced nephropathy.

Methods: We examined the association of clinical, angiographic and procedural variables with contrast volume administered during 1330 CTO-PCI procedures performed at 12 experienced United States centers.

Results: Technical and procedural success was 90% and 88%, respectively, and mean contrast volume was 289 ± 138 mL. Approximately 33% of patients received >320 mL of contrast (high contrast utilization group). On univariable analysis, male gender (P=.01), smoking (P=.01), prior coronary artery bypass graft surgery (P=.04), moderate or severe calcification (P=.01), moderate or severe tortuosity (P=.04), proximal cap ambiguity (P=.01), distal cap at a bifurcation (P<.001), side branch at the proximal cap (P<.001), blunt/no stump (P=.01), occlusion length (P<.001), higher J-CTO score (P=.02), use of antegrade dissection and reentry or retrograde approach (P<.001), ad hoc CTO-PCI (P=.04), dual arterial access (P<.001), and 8 Fr guide catheters (P<.001) were associated with higher contrast volume; conversely, diabetes mellitus (P=.01) and in-stent restenosis (P=.01) were associated with lower contrast volume. On multivariable analysis, moderate/severe calcification (P=.04), distal cap at a bifurcation (P<.001), ad hoc CTO-PCI (P<.001), dual arterial access (P=.01), 8 Fr guide catheters (P=.02), and use of antegrade dissection/reentry or the retrograde approach (P<.001) were independently associated with higher contrast use, whereas diabetes (P=.02), larger target vessel diameter (P=.03), and presence of "interventional" collaterals (P<.001) were associated with lower contrast utilization.

Conclusions: Several baseline clinical, angiographic, and procedural characteristics are associated with higher contrast volume administration during CTO-PCI.

Conflict of interest statement

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Karmpaliotis is on the speaker’s bureau for Abbott Vascular, Medtronic, and Boston Scientific. Dr Wyman discloses honoraria/consulting/speaking fees from Boston Scientific, Abbott Vascular, and Asahi Intecc. Dr Alaswad reports consulting fees from Terumo and Boston Scientific; non-financial consultancy for Abbott Laboratories. Dr Yeh has received a Career Development Award (1K23HL118138) from the National Heart, Lung, and Blood Institute; he reports personal fees from Abbott Vascular and Boston Scientific; grant from Boston Scientific. Dr Jaffer is a consultant for Boston Scientific, Siemens, and Merck; he reports receipt of non-financial research support from Abbott Vascular and a research grant from National Institutes of Health (HL-R01-108229). Dr Lombardi reports equity with Bridgepoint Medical. Dr Grantham reports speaker fees, consulting, and honoraria from Boston Scientific and Asahi Intecc; research grants from Boston Scientific, Asahi Intecc, Abbott Vascular, and Medtronic. Dr Kandzari reports research/grant support and consulting honoraria from Boston Scientific and Medtronic Cardiovascular, and research/grant support from Abbott. Dr Lembo reports speaker’s bureau participation with Medtronic; advisory board consultancy for Abbott Vascular and Medtronic. Dr Parikh reports speaker’s bureau for Medtronic, Abbott Vascular, Boston Scientific, and St. Jude Medical; advisory board for Medtronic, Abbott Vascular, and Philips. Dr Green is supported by a career development award from the National Heart Lung and Blood Institute (K23 HL121142). Dr Garcia reports consulting fees from Medtronic. Dr Thompson is an employee of Boston Scientific. Dr Banerjee reports research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCare Global (spouse); intellectual property in HygeiaTel. Dr Brilakis reports personal fees/consulting/speaker honoraria from Abbott Vascular, Asahi Intecc, Elsevier, Somahlution, GE Healthcare, Cardinal Health, and St. Jude Medical; research support from Boston Scientific and InfraRedx; spouse is employee of Medtronic. The remaining authors report no conflicts of interest regarding the content herein.

Figures

FIGURE 1

Forest plot showing beta-coefficients and 95% confidence intervals for all parameters included in the multivariable model.