PMID- 31119138 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 2307-8960 (Print) IS - 2307-8960 (Electronic) IS - 2307-8960 (Linking) VI - 7 IP - 8 DP - 2019 Apr 26 TI - Optimal use of fielder XT guidewire enhances the success rate of chronic total occlusion percutaneous coronary intervention. PG - 928-939 LID - 10.12998/wjcc.v7.i8.928 [doi] AB - BACKGROUND: Chronic total occlusion (CTO) is found in 18-31% of patients who undergo coronary angiography. Successful recanalization of CTOs is associated with reduced recurrent angina pectoris rates and increased long-term survival. Although the success rate of CTO percutaneous coronary intervention (CTO-PCI) has improved, CTO-PCI remains technically challenging. The Fielder XT guidewire was designed for CTO lesions. To validate whether the use of the guidewire increases the success rate, we compared the results of CTO-PCI with or without the guidewire. We hypothesized that the use of Fielder XT guidewire can increase the success rate of CTO-PCI. AIM: To investigate whether the use of Fielder XT guidewire increases the final procedural success of CTO-PCI via the anterograde approach. METHODS: Between January 2013 and December 2015, a retrospective study was conducted on 1230 consecutive patients with CTO who received PCI via the anterograde approach at the General Hospital of Northern Theater Command. The patients were divided into an XT Group (n = 686) and a no-XT Group (n = 544) depending on whether Fielder XT guidewire was used. Both groups were compared for clinical parameters, lesion-related characteristics, procedural outcomes and in-hospital complications. The data were statistically analyzed using Pearson's chi (2) test for categorical variables, and Students' t test was used to compare the quantitative data. Significant independent factors and a risk ratio with 95% confidence interval (CI) were assessed by multivariate logistic regression analysis. RESULTS: In total, 1230 patients were recruited; 75.4% of the patients were male, and 55.8% of the patients were in the XT group. The overall success rate was 83.9%, with 87.8% in the XT group. Based on multivariate logistic regression analysis, factors positively associated with procedural success were the use of Fielder XT guidewire (P = 0.005, 95%CI: 1.172-2.380) and systolic blood pressure (P = 0.011, 95%CI: 1.003-1.022), while factors negatively associated with procedural success were blunt stump (P = 0.013, 95%CI: 1.341-11.862), male sex (P = 0.016, 95%CI: 0.363-0.902), New York Heart Association (NYHA) class (P = 0.035, 95%CI: 0.553-0.979), contrast amount (P = 0.018, 95%CI: 0.983-0.998) and occlusion time (P = 0.009, 95%CI: 0.994-0.999). No significant differences were found between the XT group and the no-XT group with respect to clinical parameters, lesion-related characteristics, coronary artery rupture [3 (0.4%) vs 8 (1.5%), P = 0.056], in-hospital death [2 (0.3%) vs 6 (1.1%), P = 0.079] or in-hospital target lesion revascularization [3 (0.4%) vs 7 (1.3%), P < 0.099]. However, there were significant differences between the groups with respect to success rate [602 (87.8%) vs 430 (79.0%), P < 0.001], procedure time [(74 +/- 23) vs (83 +/- 21), P < 0.001], stent length [(32.0 +/- 15.8) vs (37.3 +/- 17.6), P < 0.001], contrast amount [(148 +/- 46) vs (166 +/- 43), P < 0.001], post-PCI myocardial infarction [43 (6.3%) vs 59 (10.8%), P = 0.004], major adverse cardiovascular event [44 (6.4%) vs 57 (10.7%), P = 0.007], side branch loss [31 (4.5%) vs 44 (8.1%), P = 0.009], contrast-induced nephropathy [29 (4.2%) vs 40 (7.4%), P = 0.018] and no reflow [8 (1.2%) vs 14 (2.9%), P = 0.034]. CONCLUSION: The use of Fielder XT guidewire shortens the Procedure and increases the success rate of CTO-PCI, and is also associated with reduced complication rates. FAU - Wang, Qian-Cheng AU - Wang QC AD - Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. FAU - Lin, Hai-Ruo AU - Lin HR AD - Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. FAU - Han, Yuan AU - Han Y AD - Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. FAU - Dong, Hai AU - Dong H AD - Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China. FAU - Xu, Kai AU - Xu K AD - Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China. FAU - Guan, Shao-Yi AU - Guan SY AD - Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China. FAU - Chen, Zhen-Huan AU - Chen ZH AD - Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. FAU - Hao, Hui-Xin AU - Hao HX AD - Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. FAU - Bin, Jian-Ping AU - Bin JP AD - Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. FAU - Liao, Yu-Lin AU - Liao YL AD - Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China. liao18@msn.com. FAU - Jing, Quan-Min AU - Jing QM AD - Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110000, Liaoning Province, China. LA - eng PT - Journal Article PL - United States TA - World J Clin Cases JT - World journal of clinical cases JID - 101618806 PMC - PMC6509270 OTO - NOTNLM OT - Anterograde wire escalation OT - Chronic total occlusion OT - Fielder XT guidewire OT - Parallel wire technique OT - Percutaneous coronary intervention OT - Success rate COIS- Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript. EDAT- 2019/05/24 06:00 MHDA- 2019/05/24 06:01 PMCR- 2019/04/26 CRDT- 2019/05/24 06:00 PHST- 2019/01/30 00:00 [received] PHST- 2019/03/22 00:00 [revised] PHST- 2019/04/09 00:00 [accepted] PHST- 2019/05/24 06:00 [entrez] PHST- 2019/05/24 06:00 [pubmed] PHST- 2019/05/24 06:01 [medline] PHST- 2019/04/26 00:00 [pmc-release] AID - 10.12998/wjcc.v7.i8.928 [doi] PST - ppublish SO - World J Clin Cases. 2019 Apr 26;7(8):928-939. doi: 10.12998/wjcc.v7.i8.928.