Comparative Analysis of Polymer vs Non-Polymer Jacketed Wires in Chronic Total Occlusion Percutaneous Coronary Intervention.

There is significant variation in wire utilization patterns for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The aim of this study was to compare the outcomes of polymer-jacketed wires (PJWs) versus non-PJWs in antegrade procedures. We analyzed clinical and angiographic characteristics, and procedural outcomes of 7,575 antegrade CTO PCIs that were performed at 47 centers between 2012 and 2023. Cases in which PJWs were exclusively used were classified in the PJW group, while cases where at least one non-PJW was employed were classified in the non-PJW group. Study endpoints were: technical success, coronary perforation, MACE. PJWs were exclusively used in 3,481 cases (46.0%). These cases had lower prevalence of proximal cap ambiguity, blunt stump, and moderate/severe calcification. They also had lower J-CTO, PROGRESS-CTO, and PROGRESS-CTO complications scores, higher technical success (94.3% vs 85.7%, p<0.001), and lower perforation rates (2.2% vs. 3.2%, p=0.013). Major adverse cardiac event rates did not differ between groups (1.3% vs. 1.5%, p=0.53). Exclusive use of PJWs was independently associated with higher technical success in both the multivariable (odds ratio [OR] 2.66, 95% confidence interval [CI] 2.13, 3.36, p<0.001) and inverse probability of treatment weight (IPTW) analysis (OR 2.43, 95% CI 2.04-2.89, p<0.001). Exclusive use of PJWs was associated with lower risk of perforation in the multivariable analysis (OR 0.69, 95%CI 0.49-0.95, p=0.02), and showed a similar trend in the IPTW analysis (OR 0.77, 95%CI 0.57-1.04, p=0.09). Exclusive use of PJWs is associated with higher technical success and lower perforation risk in this non-randomized series of patients.

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Declaration of competing interest Dr. Choi: Medtronic advisory board. Dr. Poommipanit: consultant for Asahi Intecc, and Abbott Vascular. Dr. Alaswad: consultant and speaker for Boston Scientific, Abbott Cardiovascular, Teleflex, and Cardiovascular Systems Inc. Dr. Basir: consultant for Abbott Vascular, Abiomed, Cardiovascular Systems, Inc (CSI), Chiesi, and Zoll. Dr. Davies: speaking honoraria from Abiomed, Asahi Intec, Boston Scientific, Medtronic, Teleflex and Shockwave medical. She also serves on advisory boards for Abiomed, Avinger, Boston Scientific, Medtronic and Rampart. Dr. Jaffer has done sponsored research for Canon, Siemens, Shockwave, Teleflex, Mercator, and Boston Scientific; and has been a consultant for Boston Scientific, Siemens, Magenta Medical, IMDS, Asahi Intecc, Biotronik, Philips, and Intravascular Imaging Inc. He has equity interest in Intravascular Imaging Inc, DurVena; and the right to receive royalties through Massachusetts General Hospital licensing arrangements with Terumo, Canon and Spectrawave. Dr. Kearney: consultant fee/Honoraria/Speaker's bureau (Personal): Boston Scientific Corporation; Abiomed; Cardiovascular Systems, Inc; Grant Support/Research Contract (Personal)—Teleflex. Dr. ElGuindy: Consulting Honoraria: Medtronic, Boston Scientific, Asahi Intecc, Terumo; Proctorship fees: Medtronic, Boston Scientific, Asahi Intecc, Terumo. Dr. Abi‐Rafeh: Proctor and speaker honoraria from Boston Scientific and Shockwave medical. Dr. Khatri: has received personal honoraria for proctoring and speaking from Abbott Vascular, Medtronic, Terumo, Shockwave, and Boston Scientific. Dr. Burke: consulting and speaker honoraria from Abbott Vascular and Boston Scientific. Dr. Sandoval: Abbott Diagnostics, Roche Diagnostics, Zoll, Phillips, JACC Advances (Associate Editor). Patent 20210401347. Dr. Lombardi received consulting fees from Abiomed, Abbott Vascular, Boston Scientific, Medtronic, Teleflex, and Cardiovascular Systems, Inc. Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, IMDS, Medicure, Medtronic, Siemens, Teleflex, and Terumo; research support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health, Stallion Medical. Dr. Azzalini received consulting fees from Teleflex, Abiomed, GE Healthcare, Abbott Vascular, Reflow Medical, and Cardiovascular Systems, Inc.; serves on the advisory board of Abiomed and GE Healthcare; owns equity in Reflow Medical. All other authors: nothing to disclose.