NCDR CathPCI Registry Research Articles

TCT-815 The Impact of Daylight Savings Time on Clinical Outcomes in Patients With Acute Myocardial Infarction: Insights From the NCDR CathPCI Registry

TCT-815 The Impact of Daylight Savings Time on Clinical Outcomes in Patients With Acute Myocardial Infarction: Insights From the NCDR CathPCI Registry

Technical success and long-term experience of a novel radial guide-catheter shape: the JCLRAD.

Percutaneous coronary intervention (PCI) via the transradial route has been widely adopted over the transfemoral route, but guide catheter selection remains limited. We present our experience with a novel guide catheter design, the Judkin’s Curve Left- Radial (JCLRAD, Medtronic), which is optimized for transradial PCI to the left coronary system. Sequential patients who underwent PCI using the JCLRAD catheter over a 3-year period (October 1, 2017 to November 1, 2020) were included in the analysis. Prospectively collected data were extracted from the institutional NCDR CathPCI registry with supplemental medical record review to collect clinical and procedural data. PCI was performed in 2347 patients and 4070 lesions using the JCLRAD guide catheter. The mean age was 65.5 ± 11.7 years, and 72.1% of the population were male; 52.5% of patients presented with acute coronary syndrome. The lesion complexity was high (66.7% Class B2/C by ACCAHA classification) with a 7% use of atherectomy. Procedural success was 99.6% with no identified cases of iatrogenic catheter-induced coronary dissection. In this single-center retrospective study, the use of the JCLRAD was associated with a high success rate and low rates of complications, including no guide catheter-induced dissection in a cohort of patients with complex coronary anatomy. This is the first-reported large clinical experience with this novel radial left coronary system guide catheter.

Abstract 16273: Contemporary Risk Prediction Model for In-Hospital or 30-day Mortality After Percutaneous Coronary Interventions: An NCDR CathPCI Registry Model

Introduction: While the ACC NCDR CathPCI registry has long provided risk-adjusted benchmarking of in-hospital mortality after percutaneous coronary intervention (PCI), extending follow-up to 30 days in those who are discharged can provide a more comprehensive assessment of post-PCI outcomes. Aims: We sought to develop a new model for predicting in-hospital or 30-day mortality after PCI with excellent discrimination to be used for quality improvement efforts. Methods: Data from 472,594 PCIs performed in 2019 at 1,369 sites from the CathPCI registry linked to National Death Index data were used to identify pre-procedural and angiographic predictors of mortality and develop a predictive model of in-hospital or 30-day mortality. A thousand bootstrapped samples of the development cohort were created, and stepwise logistic regression was performed on each sample. The final model included variables that were selected in at least 70% of the bootstrapped samples. Results: The overall in-hospital or 30-day mortality rate after PCI in the entire cohort was 2.8%. In those undergoing elective PCI without shock or clinical instability, mortality was 0.5%, while in those undergoing salvage PCI or for refractory shock it was 60.3% . Cardiovascular instability, level of consciousness after cardiac arrest, frailty, and chronic kidney disease stage were the factors most predictive of mortality (Table 1). The full model performed well with good discrimination in the overall population (C-index= 0.907), and in the cohorts of patients with STEMI (c-index=0.899), and cardiac arrest or shock (c-index=0.828), as well as across the spectrum of procedural risk. Conclusions: This risk model can accurately predict in-hospital or 30-day mortality in those undergoing PCI by incorporating variables that capture cardiovascular instability and clinical status. Extending the mortality follow-up period should enable for a more standardized evaluation of outcomes across hospitals.

Temporal Trends in Risk Factors of Periprocedural Stroke in Patients Undergoing Percutaneous Coronary Intervention: Insights from the ACC NCDR CathPCI Registry

Temporal Trends in Risk Factors of Periprocedural Stroke in Patients Undergoing Percutaneous Coronary Intervention: Insights from the ACC NCDR CathPCI Registry

Outcomes and Institutional Variation in Arterial Access Among Patients With AMI and Cardiogenic Shock Undergoing PCI

BackgroundContemporary data comparing the outcomes of transradial access (TRA) vs transfemoral access (TFA) among patients presenting with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) are limited. ObjectivesThis study examines in-hospital outcomes and institutional variation among patients with AMI-CS undergoing TRA-PCI vs TFA-PCI. MethodsPatients admitted with AMI-CS from the NCDR CathPCI registry between April 2018 and June 2021 were included. Multivariable logistic regression and inverse probability weighting models were used to assess the association between access site and in-hospital outcomes. A falsification analysis using non-access site–related bleeding was performed. ResultsAmong 35,944 patients with AMI-CS undergoing PCI, 25.6% were performed with TRA. The proportion of TRA-PCI increased over the study period (22.0% in the second quarter of 2018 vs 29.1% in the second quarter of 2021; P-trend <0.001). Significant institutional-level variability in the use of TRA-PCI was also observed: 20.9% of all sites using TRA in <2% of PCIs (low utilization) vs 1.9% of all sites using TRA in >80% of PCIs (high utilization). Patients undergoing TRA-PCI had a significantly lower adjusted incidence of major bleeding (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.67-0.76), mortality (OR: 0.73; 95% CI: 0.69-0.78), vascular complications (OR: 0.67; 95% CI: 0.54-0.84), and new dialysis (OR: 0.86; 95% CI: 0.77-0.97). There was no difference in non-access site related bleeding (OR: 0.93; 95% CI: 0.84-1.03). Sensitivity analyses revealed similar benefit with TRA-PCI among patients without arterial cross-over. There were no significant interactions observed between TRA-PCI with mechanical circulatory support and in-hospital outcomes. ConclusionsIn this large nationwide contemporary analysis of patients with AMI-CS, about quarter of PCIs were performed via TRA with wide variability across US institutions. TRA-PCI was associated with significantly lower incidence of in-hospital major bleeding, mortality, vascular complications, and new dialysis. This benefit was observed irrespective of mechanical circulatory support use.

A-54 | The Disrupt CAD III Post-Approval Study: Real-World Safety and Effectiveness of Coronary Intravascular Lithotripsy from the ACC NCDR CathPCI Registry

A-54 | The Disrupt CAD III Post-Approval Study: Real-World Safety and Effectiveness of Coronary Intravascular Lithotripsy from the ACC NCDR CathPCI Registry

Abstract 14396: Periprocedural Myocardial Injury After Elective Percutaneous Coronary Intervention is Associated With Excess Long-Term Mortality

Introduction: Periprocedural myocardial injury (pMI), characterized by elevations in circulating cardiac biomarkers, is common following percutaneous coronary intervention (PCI) for stable ischemic heart disease. We sought to characterize incidence, risk factors, and long-term outcomes of pMI early after PCI. Methods: Patients who underwent elective PCI at a large academic medical center between 2011 and 2020 were included in this retrospective, observational study. We characterized patient and procedural characteristics from local submissions to the NCDR CathPCI registry. All patients underwent routine measurements of CK-MB at 1 and 3 hours post-PCI. Patients with abnormal CK-MB or troponin pre-PCI were excluded. For patients with multiple PCI, only the first PCI was included in the analysis. pMI was defined as any post-PCI CK-MB &gt;99th percentile upper reference limit of the assay. The primary outcome was all-cause mortality derived from the Social Security Administration Death Master File. Cox proportional hazards models were generated to estimate the hazard of mortality associated with pMI. Results: We identified 10,923 patients undergoing elective PCI with routine post-PCI CK-MB measurement, with 47,959 patient-years of follow-up (mean: 4.4 years, range: 0 - 9.7). pMI occurred in 1843 cases (16.9%). Patients with pMI were older, more likely to be men, and had a higher burden of cardiovascular risk factors compared to those without pMI ( Table ). Over long-term follow-up, 483 patients (4.4%) died. Long-term, all-cause mortality was higher among patients with versus without pMI (8.0% vs. 3.7%, p&lt;0.001). After adjustment for age and sex, pMI was associated with an excess hazard for long-term mortality (hazard ratio 1.48, 95% CI 1.22-1.80). Conclusion: Myocardial injury detected early after PCI is common and is associated with increased long-term all-cause mortality. Efforts to reduce pMI incidence are needed.

Comparing the Classification of Percutaneous Coronary Interventions Using the 2012 and 2017 Appropriate Use Criteria: Insights From 245,196 Patients in the NCDR CathPCI Registry

BackgroundAppropriate use criteria (AUC) have been developed to promote the rational use of percutaneous coronary intervention (PCI) among clinicians and to provide benchmarking feedback to hospitals. The original AUC were published in 2012 and subsequently updated in 2017 to reflect emerging, contemporary evidence however the degree to which the updated guidance re-classifies PCI appropriateness is unknown. MethodsElective PCI cases from March 1, 2018 until June 30, 2021 were identified from within the NCDR CathPCI database. PCI cases were classified as ‘appropriate,’ ‘uncertain’ or ‘inappropriate’ under 2012 AUC and ‘appropriate,’ ‘may be appropriate’ or ‘rarely appropriate’ under 2017 AUC; those with missing data elements were termed ‘not mappable.’ Groups that ‘remained appropriate’ (appropriate in both 2012 and 2017), ‘became non-appropriate’ (‘appropriate’ in 2012 but became either ‘may be appropriate’ or ‘rarely appropriate in 2017) and ‘became appropriate’ (‘appropriate’ in 2017 but were ‘uncertain’ or ‘inappropriate’ in 2012) were descriptively compared. Concordance was assessed by calculation of Cohen's Kappa. ResultsA total of 245,196 patients underwent elective PCI across 1669 centers. By 2012 AUC, 44% were classified ‘appropriate,’ 28% were ‘uncertain’ and 16% were ‘inappropriate’ compared with 2017 AUC which considered 34% ‘appropriate’, 56% may be ‘appropriate’ and 4% ‘rarely appropriate’. Overall fair agreement was observed with a Kappa statistic of 0.40 (95%CI 0.396-0.403). Compared with PCI that ‘remained appropriate’ under the 2017 AUC, PCI that ‘became non-appropriate’ in 2017 were more likely to be asymptomatic, less likely to be on anti-anginals and less likely to have complex lesions. Compared with PCI that ‘became non-appropriate’, PCI that ‘became appropriate’ had a higher proportion of atypical and non-anginal symptoms and were less likely to have had positive functional tests. Procedural related outcomes were similar across all groups. A total of 29 429 PCI (12.0%) were not mappable by 2012 AUC while 16 077 (6.6%) were not mappable by 2017 AUC. ConclusionsIn this contemporary analysis of patients undergoing PCI in the United States, only fair agreement between the 2012 and updated 2017 AUC was observed. While some of this reflects the intention of the updated guidance, the large proportion that were considered ‘maybe appropriate’ or who ‘became non-appropriate’ reflect the difficulties of documenting and implementing contemporary AUC guidance.

A-24 | Association of COVD-19 Pandemic with Percutaneous Coronary Interventions for ST Elevation Myocardial Infarction within a Large National Healthcare System

Several centers reported an impact on STEMI volumes during the COVID-19 pandemic. Ascension Heath’s NCDR CathPCI registry monitors percutaneous interventions (PCI) for STEMI across the nation’s largest nonprofit healthcare system.

Abstract 13905: Radial vs Femoral Approach for Cardiac Catheterization With or Without Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Grafting

Background: Owing to reduced bleeding risks, radial is favored over femoral for access site selection in patients referred for coronary angiography, with specific benefits in patients presenting with acute coronary syndrome. However, studies were often limited to patients without coronary artery bypass grafts (CABG), given the technical challenges of the radial approach in these patients. Methods: We evaluated patients with prior CABG undergoing coronary angiography with or without percutaneous coronary intervention (PCI) from 2015-2020 at our institution. We reviewed access site and bleeding outcomes as defined in the NCDR CathPCI registry. Additional outcomes included procedural duration, fluoroscopy time, contrast volume, and clinical events. Results: Of the 1,546 patients studied, 280 (18%) patients had radial access while 1,266 (82%) patients had femoral access. Over the study time period, frequency of radial access for post CABG catheterization procedures increased from 0% in 2015 to 45% in 2020. There were no statistically significant differences in comorbidities, bleeding events, complications, or mortality between radial vs femoral (Table). Fluoroscopy time was higher for radial vs femoral (14.9 mins vs 13.3 mins, p=0.04). Conclusion: Over time, radial access choice in post CABG patients increased, without significant differences with respect to bleeding events or complications as compared to femoral, though at increased fluoroscopy times.

Abstract 9972: Estimation of DAPT Study Treatment Effects in Contemporary Clinical Practice: Findings from the EXTEND-DAPT Study

Introduction: Differences in patient characteristics, changes in treatment algorithms, and advances in medical technology could each influence the applicability of older randomized trial results to contemporary clinical practice. Objectives: To evaluate whether the Dual Antiplatelet Therapy (DAPT) Study population is different from a contemporary population of US patients receiving percutaneous coronary intervention (PCI), and to estimate the treatment effect of extended duration antiplatelet therapy after PCI in this more contemporary cohort. Methods: We compared characteristics of drug-eluting stent (DES)-treated patients randomized in the DAPT Study to a sample of more contemporary DES-treated patients in the NCDR CathPCI Registry from July 2016-June 2017. After linking trial and registry data, we employed inverse-odds of trial participation weighting to account for patient and procedural characteristics and estimated a contemporary “real-world” treatment effect of 30 vs. 12 months of DAPT after coronary stent procedures. Results: The US DES-treated trial cohort included 8864 DAPT Study patients and the registry cohort included 568,540 patients. Compared to the trial population, registry patients had more comorbidities and were more likely to present with myocardial infarction and receive 2nd generation DES. After reweighting trial results to represent the registry population, there was no longer a significant effect of prolonged DAPT on reducing stent thrombosis (reweighted treatment effect: -0.40, 95% CI: -0.99%, 0.15%), MACCE ( reweighted treatment effect: -0.52, 95% CI: -2.62%, 1.03%), or MI (reweighted treatment effect: -0.97%, 95% CI: -2.75%, 0.18%), but the increase in bleeding with prolonged DAPT persisted (reweighted treatment effect: 2.42%, 95% CI: 0.79%, 3.91%). Conclusions: Differences between patients and devices used in contemporary clinical practice compared with the DAPT Study may be associated with attenuation of benefits and relatively greater harms attributable to prolonged DAPT duration. These findings may limit applicability of average treatment effects from the DAPT Study in modern clinical practice.

Abstract 11557: Rates of Early Target Vessel Revascularization and Target Lesion Revascularization Amongst Third Generation Drug-Eluting Stents

Background: While the benefits of drug-eluting stents (DES) during percutaneous coronary intervention (PCI) are well established, the frequency and timing of repeat revascularization events, particularly early events, is not well described in contemporary clinical practice. Methods: Patients undergoing PCI at two large tertiary centers in a single health system from April 2014 to December 2019 were prospectively enrolled into the NCDR CathPCI Registry. Target vessel revascularization (TVR) and target lesion revascularization (TLR) were defined as a repeat intervention to the index vessel or lesion respectively and determined by linking to subsequent PCI events and CABG admissions in the EMR. Early TVR and TLR rates were identified at 30 days, 90 days, six months, and one year. Logistic regression was used to estimate the association between stent type and TVR/TLR at the pre-specified time points. Generalized estimating equations with nested modeling were used to account for patients with multiple vessels and lesions. Results: Overall, 8,221 PCI procedures were identified in 7,128 patients with 9,558 vessel interventions and 12,019 lesion interventions. There were similar rates of TVR for Zotarolimus eluting durable polymer stents (ZES-DP), Everolimus eluting bioabsorbable polymer stents (EES-BAP), and Everolimus eluting durable polymer stents (EES-DP) at 30 days (p=0.61), 90 days (p=0.79), six months (p=0.58), and one year (p= 0.35). There were similarly no differences in TLR between stent types at each time point (p= 0.57, 0.79, 0.16, 0.13 respectively). The total rates of TLR and TVR progressed linearly throughout the year following PCI with nearly half of all repeat revascularization events occurring within 6 months. Table 1. Conclusions: Within a single health system from 2014 to 2019, ZES-DP, EES-BAP, and EES-DP were associated with similar rates of TVR and TLR. These events appear to occur earlier than typically reported in clinical trials.

TCT-167 Utilization Rates and In-Hospital Outcomes Associated With Intravascular Imaging–Guided PCI in the USA: An Analysis of the NCDR CathPCI Registry

TCT-167 Utilization Rates and In-Hospital Outcomes Associated With Intravascular Imaging–Guided PCI in the USA: An Analysis of the NCDR CathPCI Registry

Abstract 317: Implications of the Ischemia Trial Results on Appropriateness of Percutaneous Coronary Intervention for Stable Coronary Artery Disease: Insights From the Ncdr Cathpci Registry

Background: The recent ISCHEMIA trial found that percutaneous coronary intervention (PCI) did not reduce rates of cardiovascular events (death, myocardial infarction) in patients with stable ischemic heart disease (SIHD), regardless of ischemic burden, but improved patients’ health status, if they had angina. These findings have significant implications for appropriate use criteria (AUC) for PCI and suggest that PCI in asymptomatic patients may be classified as rarely appropriate given the lack of cardiovascular event or health status benefit. Methods: Patients with SIHD, who were enrolled in the NCDR Cath-PCI registry v5, from April 1 st , 2018 to June 30 th , 2019 were included in this study. To examine the potential implication of the ISCHEMIA trial on AUC, we modified the AUC definition to reclassify PCIs in asymptomatic patients with SIHD (without left main coronary artery involvement) as rarely appropriate. We then compared the current and modified AUCs. Results: Our final analytical cohort included 324,715 patients (mean age 67.9 years, 11.3% non-Caucasian, 30.4% females). At baseline, comorbidities were common with 42.9% having diabetes, 56.8% being current or recent smokers and 16.0% having chronic lung disease. Based on the current AUC definition, 113,110 (34.8%) PCIs were classified as appropriate, 79,859 (24.6%) as maybe appropriate, 6,660(2.1%) as rarely appropriate, and 125,086 (38.5%) could not be classified. Recategorizing the AUCs based on ISCHEMIA, 51,502 (15.9%) PCIs were classified as rarely appropriate; with 22,753 being reclassified from maybe appropriate and 22,089 asymptomatic patients being reclassified from unclassifiable to rarely appropriate (Figure). Conclusion: One in five patients with SIHD who undergo PCI are asymptomatic and might not be considered rarely appropriate under current AUC. The ISCHEMIA trial may have large implications on the number and proportion of patients with SIHD considered to receive little to no benefit from elective PCI.

TCT-822 Culprit Vessel Only Versus Multivessel Percutaneous Coronary Intervention in Patients With NSTEMI and Cardiogenic Shock: Insights From the NCDR CathPCI Registry

TCT-822 Culprit Vessel Only Versus Multivessel Percutaneous Coronary Intervention in Patients With NSTEMI and Cardiogenic Shock: Insights From the NCDR CathPCI Registry

Current landscape of hybrid revascularization: A report from the NCDR CathPCI Registry

BackgroundHybrid revascularization, combining percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), may be used differently across hospitals. How outcomes compare with multivessel PCI is unknown. MethodsWe studied hybrid revascularization use in patients in the National Cardiovascular Data Registry from 2009 to 2017 who underwent PCI for multivessel coronary artery disease (CAD) at 711 hospitals, excluding patients with prior CABG, acute ST-elevation myocardial infarction, emergency/salvage CABG, or PCI without stent placement. In-hospital mortality associated with hybrid revascularization versus multivessel PCI was compared using a multivariable logistic model. ResultsAmong 775,000 patients with multivessel CAD, 1,126 (0.2%) underwent hybrid revascularization and 256,865 (33%) were treated with multivessel PCI. Although 358 (50.4%) hospitals performed hybrid revascularizations, most (97.3%) performed <1 per year. Most patients (68.7%) treated with hybrid revascularization underwent CABG after PCI; only 79.4% of these patients were discharged on P2Y12 inhibitors. Patients who underwent hybrid revascularization were younger and more likely to have significant left main or proximal left anterior descending disease. Unadjusted in-hospital mortality rates were higher among patients treated with hybrid revascularization than multivessel PCI (1.5% vs 0.9%, P = .02), a difference that was not significant after multivariable adjustment (odds ratio = 1.54, 95% CI = 0.92-2.59). ConclusionsHybrid revascularization remains an infrequently used treatment modality for multivessel CAD. Risk-adjusted in-hospital mortality was no different between hybrid revascularization and multivessel PCI; however, patients who underwent hybrid revascularization were less likely to be discharged on P2Y12 inhibitor therapy despite stent implantation.

Abstract 196: Omission of Heart Transplant Recipients from the Appropriate Use Criteria for Revascularization and Impact on High-Volume Heart Transplant Centers

Background: For heart transplant recipients, guidelines endorse routine coronary angiography and percutaneous coronary intervention (PCI) to screen for and treat cardiac allograft vasculopathy (CAV). However, current Appropriate Use Criteria for Revascularization (AUC-R) do not recognize CAV as a unique PCI indication, and thus PCI for CAV is often labeled “rarely appropriate (RA).” The AUC-R’s omission of CAV patients, and its impact on RA PCI rates and hospital pay-for-performance reimbursement have never been described. Methods: Using NCDR CathPCI Registry data, we identified all elective PCIs from 96 Medicare-approved heart transplant centers between 2009Q3 and 2017Q2. NCDR-reported rates of RA elective PCI were compared before and after exclusion of CAV patients using paired t-tests. The annual pay-for-performance financial incentives potentially lost by heart transplant centers were estimated based on AUC-R performance thresholds published by Anthem Blue Cross and Blue Shield’s Quality-In-Sights®: Hospital Incentive Program (Q-HIP®). Results: Of 168,802 elective PCIs performed in heart transplant centers, 1,854 (1.1%) were for CAV. CAV patients, compared with non-heart transplant recipients, were more frequently asymptomatic (81.9% vs. 33.4%, p&lt;0.001) and had lower rates of prior stress testing (15.0% vs. 58.4%, p&lt;0.001), resulting in higher RA PCI rates (66.0% vs 16.9%, p&lt;0.001). In transplant centers, the absolute difference in RA rates (before vs. after exclusion of CAV patients) was directly associated with the proportion of total PCIs performed in CAV patients (p&lt;0.001, Figure ). In a sample of 16 heart transplant centers participating in Q-HIP® during the 2017 calendar year measurement period, 2 (13%) centers could have each observed reimbursement increases estimated at ~$90,000 dollars if their Q-HIP® scorecards were re-scored after excluding CAV patients. Conclusion: Two-thirds of PCI cases in CAV patients are deemed RA by the AUC-R. The failure of the AUC-R to recognize CAV as a unique PCI indication may lead to inflated RA PCI rates and has the potential for substantial negative pay-for-performance implications in heart transplant centers. The AUC-R should recognize CAV as a unique PCI indication so that heart transplant centers are not penalized for performing PCI for CAV.

Adoption of the transradial approach for percutaneous coronary intervention and rates of vascular complications following transfemoral procedures: Insights from NCDR.

This study was designed to examine the association between adopting the transradial approach for percutaneous coronary intervention (PCI) and rates of vascular complications following transfemoral PCI. Recent studies raised concerns that operators adopting the transradial approach may lose their transfemoral access skills and experience increased rates of vascular complications. Retrospective analysis of data from the NCDR CathPCI Registry to examine the rates of vascular complications among physicians who were femoral operators (>90% of cases) in 2010-2011 and later adopted the transradial approach to PCI among low-, intermediate-, or high-level adopters (≤33%, 34-66%, and >66%, respectively) in 2014-2015. Propensity score matching was used to control for confounding factors. A total of 1,704,708 procedures performed by 4,697 operators were included. Most operators were low-level adopters (80.7%), followed by intermediate (15.7) and high-level adopters (3.6%). Compared to the preadoption period, vascular complications of transfemoral PCIs following transradial adoption increased among low-level adopters (1.29%-1.59%, adjusted OR [95% CI]: 1.24[1.20-1.28], P < 0.001), intermediate-level adopters (1.37%-1.92%, adjusted OR 1.40[1.29-1.53], P < 0.001), and high-level adopters (1.54%-1.93%, adjusted OR 1.26[1.00-1.58], P = 0.053).In the post-adoption period, there was increase in access site bleeding that is likely due to change in registry definition. There was no increase in hematomas, retroperitoneal bleeding or other vascular complications. Adoption of the transradial approach for PCI is not associated with clinically meaningful increase in rates of vascular complications of transfemoral PCIs.

TCT-605 Examining the Operator Learning Curve for Percutaneous Coronary Intervention of Chronic Total Occlusions

Advances in CTO techniques have led to rising procedural success rates among experienced operators. The learning curve for new CTO operators has not been well-defined. From the NCDR CathPCI Registry, 93,875 CTO PCI cases were extracted between July 2009 and December 2015. We delineated a cohort of

TCT-331 Clinical Characteristics and Outcomes in Patients Undergoing PCI to LIMA Grafts: a Study From the ACC NCDR CathPCI Registry

There are limited studies of percutaneous coronary intervention (PCI) of left internal mammary artery (LIMA) grafts. Participants in the National Cardiovascular Data CathPCI Registry undergoing PCI of a bypass graft to the left anterior descending artery (LAD) from July 2009−December 2011 were