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Angiographic analysis of immediate and long-term results of PTCR vs. PTCA in complex lesions (COBRA study)
U Dietz1, H J Rupprecht, O Ekinci
1University Hospital Mainz, Mainz, Germany. kardio.dietz@dkd-wiesbaden.de
Insights
Percutaneous transluminal coronary angioplasty (PTCA) and high-frequency rotational atherectomy (PTCR) showed similar success and restenosis rates for complex coronary lesions. However, PTCR resulted in greater late loss and smaller net gain compared to PTCA.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Complex coronary artery lesions (AHA type B2 and C) pose treatment challenges.
- Percutaneous coronary interventions aim to improve blood flow and reduce symptoms.
Purpose of the Study:
- To compare the immediate and long-term angiographic outcomes of percutaneous transluminal coronary angioplasty (PTCA) and high-frequency rotational atherectomy (PTCR) for complex coronary lesions.
- To analyze the relationship between lesion characteristics and procedural results.
Main Methods:
- Prospective, randomized trial comparing PTCA (n=250) and PTCR (n=252).
- Quantitative coronary angiography for immediate results and 6-month follow-up in 447 and 293 patients, respectively.
- Evaluation of procedural success, need for stent implantation, diameter stenosis, minimal lumen diameter (MLD), acute gain, late loss, and restenosis rates.
Main Results:
- Comparable procedural success (80% PTCR vs. 76% PTCA) and 6-month restenosis rates (37% PTCR vs. 35% PTCA).
- Higher need for stenting in PTCA group (9.7% vs. 2.0%).
- PTCR showed significantly more severe diameter stenosis (52% vs. 46%) and smaller MLD (1.29 mm vs. 1.44 mm) at 6 months, with greater late loss and smaller net gain.
Conclusions:
- Both PTCA and PTCR are effective for complex coronary lesions regarding angiographic and procedural success, and restenosis rates.
- PTCR is associated with worse long-term results, including higher late loss and lower net gain.
- Stent use impacted immediate PTCA results but not long-term outcomes.
Abstract:
We conducted a prospective, randomized trial to compare immediate and long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and high-frequency rotational atherectomy (PTCR) in patients with angiographically predefined complex coronary artery lesions (AHA type B2 and C). The relation of lesion characteristics to procedural results is reported in this angiographic analysis. Patients were randomly assigned to balloon angioplasty (n = 250 patients) or rotational atherectomy (n = 252 patients). Quantitative coronary angiography could be performed in 447 patients to evaluate immediate results and in 293 patients with a 6-month angiographic follow-up. Procedural success was comparable in the PTCR and in the PTCA group (80% vs. 76%, P = 0.260). The need for stent implantation due to a residual stenosis >50% or a bail-out situation was significantly higher in the PTCA group (9.7% vs. 2.0%, P = 0.001). In both treatment groups, diameter stenosis was effectively reduced and MLD increased. The acute gain did not differ between the two groups. At 6-month control, the restenosis rate was comparable in the PTCR and in the PTCA group (37% vs. 35%, P = 0.658), whereas diameter stenosis was significantly more severe in the PTCR group than in the PTCA group (52% vs. 46%, P = 0.039) and, correspondingly, the MLD was significantly smaller in the PTCR group (1.29 mm vs. 1.44 mm, P = 0.031). Late loss was about the same in both groups, however, net gain and net gain index were significantly higher in the PTCA group (0.82 mm vs. 0.64 mm, P = 0.008; and 31% vs. 24%, P = 0.009). Analysis of procedural results for various lesion characteristics revealed no significant difference between treatment groups. In this randomized trial, complex coronary artery lesions were treated with comparable results for angiographic and procedural success and the restenosis rate by both, PTCA and PTCR. Late loss, however, was significantly higher and net gain significantly smaller after PTCR. Stents, although infrequently used, had a relevant impact on immediate PTCA results but not on late results. Cathet Cardiovasc Intervent 2001;53:359-367.