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Long-term outcomes of rotational atherectomy in coronary bifurcation lesions

Yuxiang Dai1, Atsutoshi Takagi2, Hakuoh Konishi2

  • 1Department of Cardiology, Juntendo University Hospital, Tokyo 113-8421, Japan ; Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.

Experimental and Therapeutic Medicine
|December 16, 2015
PubMed

Insights

This study found that diabetes mellitus (DM) is an independent risk factor for adverse outcomes in patients with coronary bifurcation lesions treated with rotational atherectomy (ROTA). DM patients experienced higher rates of restenosis and major adverse cardiac events, necessitating further investigation into specialized management strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diabetes Mellitus Research

Background:

  • Coronary artery bifurcation lesions pose unique challenges in percutaneous coronary intervention.
  • Rotational atherectomy (ROTA) is a technique used to debulk complex lesions, including those at bifurcations.
  • The long-term impact of diabetes mellitus (DM) on outcomes after ROTA for bifurcation lesions requires further elucidation.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of patients with coronary bifurcation lesions treated with ROTA.
  • To compare outcomes between diabetic (DM) and non-diabetic patients undergoing ROTA for bifurcation lesions.
  • To identify risk factors influencing restenosis and major adverse cardiac events (MACE) in this patient cohort.

Main Methods:

  • Retrospective study of 337 patients undergoing ROTA for bifurcation lesions between January 2007 and December 2009.
  • Patients were followed for a median of 48 months (range, 12-84 months).
  • Comparison of angiographic and clinical outcomes, including target lesion revascularization (TLR), restenosis, and MACE, between DM and non-DM groups.

Main Results:

  • Diabetic patients showed significantly decreased minimal lumen diameter (MLD) and increased diameter stenosis (%DS) at follow-up compared to non-diabetic patients.
  • DM patients experienced significantly higher rates of TLR (15.7% vs. 5.0%), TL restenosis (25.8% vs. 12.6%), and MACE (20.2% vs. 12.0%).
  • Despite improvements with ROTA and drug-eluting stents, DM remained an independent predictor of adverse outcomes.

Conclusions:

  • Rotational atherectomy and drug-eluting stents improve long-term outcomes for bifurcation lesions.
  • Diabetes mellitus is an independent risk factor for target lesion revascularization, restenosis, and MACE in patients treated with ROTA for bifurcation lesions.
  • Enhanced management strategies for DM in patients with bifurcation lesions undergoing ROTA warrant further investigation.

Keywords:
coronary bifurcation lesionlong-term outcomesrotational atherectomy

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