Abstract 14955: Factors Associated With High Contrast Utilization During Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Contemporary Multicenter Registry

Abstract

Background: High contrast utilization during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) may lead to peri-procedural complications, in particular contrast-induced nephropathy (CIN). Methods: We examined the association between several clinical and angiographic variables and contrast volume utilization during CTO PCI among 950 consecutive procedures performed at 10 experienced US centers between May 2012 and March 2015. Results: Mean age was 65±10 years, 87% of patients were men, and 34% had prior coronary artery bypass graft surgery (CABG). Technical and procedural success was 91% and 90%, respectively. The median contrast volume utilization was 260 (IQR:195, 360) mL. Approximately 33% of patients received >310mL of contrast (high contrast utilization). On univariable analysis male gender (p=0.017), moderate or severe calcification (p=0.002) and tortuosity (p=0.004), proximal cap ambiguity (p=0.002), distal cap at a bifurcation (p=0.001), side branch at proximal cap (p=0.02), blunt/no stump (p=0.003), occlusion length (p<0.0001), high J-CTO score (p=0.012), guide catheter size (>7F) (p<0.0001), retrograde approach (p=0.006), ad-hoc CTO PCI (p<0.0001) and dual arterial access (p<0.0001) were associated with higher contrast administration, whereas history of diabetes mellitus (p=0.008) and in-stent restenosis (p=0.049) were associated with less contrast use. On multivariable analysis proximal cap ambiguity (p=0.030), bigger guide catheter size (p=0.007), ad-hoc CTO PCI (p<0.0001) and dual arterial access (p=0.002) were independently associated with higher contrast use during CTO PCI. On the other hand, in-stent restenosis (p=0.027) and presence of interventional collaterals (p<0.0001) were associated with lower contrast use. Conclusions: Approximately 1 in 3 patients undergoing CTO PCI receive high contrast volume (>310 mL). Several baseline clinical and angiographic characteristics can help predict the likelihood of high contrast volume administration. This knowledge could be used pre-procedurally and intra-procedurally to guide and intensify efforts to reduce contrast utilization and reduce the risk of contrast-induced complications during CTO PCI.