Related Experiment Videos
Long-term results of directional coronary atherectomy: predictors of restenosis
R F Fishman1, R E Kuntz, J P Carrozza
1Charles A. Dana Research Laboratory Institute, Beth Israel Hospital, Boston, Massachusetts 02215.
Insights
Directional coronary atherectomy showed a 32% restenosis rate at six months, with better outcomes for patients with larger post-procedure lumen diameter, lower cholesterol, or recent myocardial infarction. Few events occurred after the first year.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Directional coronary atherectomy (DCA) offers favorable acute results but faces limited adoption due to concerns about long-term restenosis rates compared to conventional angioplasty.
- Understanding the long-term clinical efficacy of DCA is crucial for its appropriate application in interventional cardiology.
Purpose of the Study:
- To evaluate the long-term clinical efficacy and restenosis rates of directional coronary atherectomy.
- To identify predictors of restenosis following directional coronary atherectomy.
Main Methods:
- A retrospective analysis of 225 directional coronary atherectomies in 190 patients performed between August 1988 and July 1991.
- Angiographic measurements of minimal lumen diameter were taken before, immediately after, and at 6-month follow-up.
- Life-table analysis was used to assess long-term outcomes, including mortality and other cardiac events.
Main Results:
- Procedural success was achieved in 91% of atherectomies, with 98% success after subsequent balloon angioplasty.
- The overall 6-month angiographic restenosis rate was 32%.
- Predictors of lower restenosis included postprocedure lumen diameter > 3 mm (24%), serum cholesterol ≤ 200 mg/dl (18%), and recent myocardial infarction (16%).
- One-year outcomes included a 2% mortality rate and a 26% incidence of other events; subsequent annual event rates were lower and largely attributed to disease progression elsewhere.
Conclusions:
- Directional coronary atherectomy demonstrated a 32% restenosis rate at 6 months, with favorable outcomes associated with specific patient and procedural characteristics.
- The incidence of atherectomy-related events significantly decreased after the first year, suggesting the procedure's durability for the treated site.
- Identifying patients with favorable predictors may optimize the use of directional coronary atherectomy in clinical practice.
Objectives:
This study was performed to obtain better understanding of the long-term clinical efficacy of directional coronary atherectomy.
Background:
Although this procedure yields favorable acute results, its acceptance has been limited by the perception that late results (that is, freedom from restenosis) are no better than those of conventional angioplasty.
Methods:
A total of 225 atherectomies performed in 190 patients between August 1988 and July 1991 were examined. Minimal lumen diameter of the treated segments was measured on angiograms obtained before, after and 6 months after intervention.
Results:
Although most lesions (97%) had one or more characteristics predictive of unfavorable short- or long-term results after conventional angioplasty, atherectomy was successful in 205 lesions (91%) with a mean residual stenosis of 7 +/- 16%. After subsequent balloon angioplasty in 16 unsuccessful atherectomy attempts, procedural success was 98%. There were no deaths or Q wave myocardial infarctions, and one patient (0.5%) underwent emergency bypass surgery. Six-month angiographic follow-up was obtained in 77% of the eligible patients. The overall angiographic restenosis rate was 32%. Predictors of a lower restenosis rate included a postprocedure lumen diameter > 3 mm (24% vs. 39%, p = 0.047), serum cholesterol < or = 200 mg/dl (18% vs. 40%, p = 0.018) and recent myocardial infarction (16% vs. 37%, p = 0.034). Life-table analysis showed a 2% mortality rate and a 26% incidence of other events (myocardial infarction, repeat revascularization) within the 1st year. The annual 5% mortality rate and 7% incidence of other events during years 2 and 3 were related in large part to the existence or progression of disease at other locations.
Conclusions:
Six-month angiographic follow-up of patients who underwent directional coronary atherectomy during the 1st 3 years of our experience shows an overall restenosis rate of 32%, with lower rates in patients with a postatherectomy lumen diameter > or = 3 mm, cholesterol level < or = 200 mg/dl or a recent myocardial infarction. Few if any events relating to the site of atherectomy developed after the 1st year of follow-up.