Contrast utilization patterns during CTO-PCI: Insights from the PROGRESS-CTO registry
Vemmou E, Alaswad K, Karmpaliotis D, Krestyaninov O, Khelimskii D, Choi JW, Khatri J, Jaffer FA, Patel MP, Mahmud E, Doing A, Dattilo P, Koutouzis M, Tsiafoutis I, Uretsky BF, Toma C, Elbarouni B, Love M, Jaber W, Samady H, Jefferson B, Patel TN, Sheikh AM, Yeh RW, Tamez H, ElGuindy A, Rafeh NA, Maallouf A, Jaoudeh FA, Xenogiannis I, Nikolakopoulos I, Rangan BV, Omer MA, Megaly MS, Gkargkoulas F, Moses JW, Lembo NJ, Kirtane AJ, Parikh MA, Ali ZA, Banerjee S, Abdullah S, Garcia S, Burke MN, and Brilakis ES. Contrast utilization patterns during CTO-PCI: Insights from the PROGRESS-CTO registry. Catheterization and Cardiovascular Interventions 2020; 95:S56-S57.
Catheterization and Cardiovascular Interventions
Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may require large contrast volume.
Methods: We examined contrast utilization in 5,440 patients undergoing CTO PCI at 30 US and international centers between 2012 and 2019. We compared the group of patients that had contrast volume above vs. below the median (240 mL).
Results: Mean age was 64.5 ±10 years, 83% of patients were men and 42% had diabetes mellitus. Median pre-procedural creatinine was 1.01 [0.76-1.2] mg/dL and 2% of patients were on dialysis. Median contrast volume was 240 [170,320] mL and decreased over time (Figure). Patients with high contrast volume were more likely to have undergone ad-hoc CTO-PCI (13.2% vs. 8.9%, p<0.0001) and had higher median J-CTO score (3 [2,3] vs. 2 [1, 3], p<0.0001). The higher contrast volume group had higher use of retrograde crossing strategy (43% vs. 27%, p<0.0001), lower procedural and technical success (82% vs. 88% and 84% vs 89%, respectively, p<0.0001), higher incidence of in-hospital major adverse events (3% vs. 1.5%, p=0.0001), and longer procedure time (139 [98,201] vs. 96 [62,148] min, p<0.0001). The use of intravascular ultrasound was associated with lower contrast volume (57% vs 43%, p<0.0001).
Conclusions: Contrast volume used during CTO-PCI has been decreasing over the years. Higher lesion complexity, procedural failure, and the occurrence of complications are associated with higher contrast volume.