074 Risk factors for procedural failure of percutaneous coronary intervention for chronic total occlusion. Impact of novel guide wire “Fielder XT”

Abstract

Chronic total occlusion (CTO) remains one of the last frontiers of percutaneous coronary intervention (PCI). Recently, a novel “soft” guidewire (GW) developed for tracking invisible micro-channels (Fielder XT) became available in France. The purpose of this study was to clarify the risk factors contributing to PCI success for CTO lesions and evaluate the efficacy and safety of this GW. The study included 166 consecutive Pts with CTO's (European CTO Club definition) who underwent primary PCI at our institution between June 2008 and Feb 2010 by 2 experienced operators. The cohort was divided into 2 groups: group 1 (n = 83), treated before availability of “Fielder XT” GW in France and group 2 (n = 83), treated since availability. Clinical and angiographic characteristics were similar in both groups (age 63.9 ± 11.3 years, lesion length 23.0 ± 18.1 mm, bridging collateral 37.%, tortuosity score 0.16 ± 0.37/1 and calcification score 0.94 ± 1.08/3). Fielder XT was used in 1 case (1.2%) in group 1 and 67 (80.7%) in group 2. Micro catheters were used more frequently in group 2 (73.2% vs 56.6%; p = 0.013) and parallel wire technique was less required (16.2% vs 31.3%; p = 0.011). Angiographic success rate was significantly higher in group 2 (84.3% vs 67.5%; p = 0.005) with a lower rate of dissection (12.2% vs 24.7%; p = 0.02) and a trend for a lower rate of perforation (4.9% vs 1.2%; p = ns). Predictors of failure in the total cohort were by multivariate logistic regression analysis: proximal tortuosity (p = 0.048, OR = 3.15), absence of bifurcation (p = 0.024, OR = 3.39), no visible stump (p<0.0001, OR = 6.25), calcification (p = 0.029, OR = 1.56) and patient in group 1 (p = 0.015, OR = 3.37). Introduction of a dedicated “soft” wire in the CTO treatment strategy improves the angiographic success rate of PCI with a more simple and “soft” technique. Multivariate analysis confirmed classical independent predictors of failure but also demonstrated that a new device may influence success rate.