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Clinical Characteristics and Long-Term Outcomes of Rotational Atherectomy - J2T Multicenter Registry
Iwao Okai1, Tomotaka Dohi1, Shinya Okazaki1
1Department of Cardiovascular Medicine, Juntendo University School of Medicine.
Insights
Rotational atherectomy (RA) for calcified coronary lesions is feasible but associated with a high incidence of major adverse cardiac events (MACE) during long-term follow-up, particularly in patients with diabetes or on hemodialysis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Rotational atherectomy (RA) is utilized for managing complex calcified coronary lesions during percutaneous coronary intervention (PCI).
- Long-term clinical outcomes following RA in the era of drug-eluting stents remain incompletely understood.
Purpose of the Study:
- To assess the long-term clinical outcomes of patients undergoing rotational atherectomy for heavily calcified coronary lesions.
- To identify predictors of major adverse cardiac events (MACE) after RA.
Main Methods:
- A multi-center registry of 1,090 patients treated with RA for calcified coronary lesions between 2004 and 2015.
- Evaluation of procedural success, in-hospital events, and long-term MACE (all-cause death, ACS, stent thrombosis, TVR, stroke) over a median follow-up of 3.8 years.
- Multivariable Cox hazard analysis to identify independent predictors of MACE.
Main Results:
- High procedural success rate (96.2%) for RA.
- In-hospital mortality was 3.0% and definite/probable stent thrombosis was 1.3%.
- Long-term MACE incidence was 46.7%, with hemodialysis and older age identified as strong independent predictors. Statin use was associated with lower MACE.
Conclusions:
- Rotational atherectomy is a feasible procedure for calcified coronary lesions, achieving high procedural success.
- Despite feasibility, a significant incidence of long-term major adverse cardiac events was observed.
- Hemodialysis and advanced age are critical risk factors for adverse outcomes post-RA.
Background:
Rotational atherectomy (RA) is an adjunct tool for the management of heavily calcified coronary lesions during percutaneous coronary intervention (PCI), but the long-term clinical outcomes of RA use remain unclear in this drug-eluting stent era.
Methods And Results:
This multi-center registry assessed the characteristics and outcomes of patients treated by RA for calcified coronary lesions between 2004 and 2015. Among 1,090 registered patients, mean age was 70±10 years and 815 (75%) were male. Sixty percent of patients had diabetes mellitus and 27.7% were receiving hemodialysis. The procedure was successful in 96.2%. In-hospital death occurred in 33 patients (3.0%), and 14 patients (1.3%) developed definite/probable stent thrombosis. During the median follow-up period of 3.8 years, the incidence of major adverse cardiac events (MACE), defined as all-cause death, acute coronary syndrome, stent thrombosis, target vessel revascularization and stroke, was 46.7%. On multivariable Cox hazard analysis, hemodialysis (HR, 2.08; 95% CI: 1.53-2.86; P<0.0001) and age (HR, 1.03; 95% CI: 1.01-1.04; P<0.0001) were strong independent predictors of MACE. Conversely, statin treatment was associated with lower incidence of MACE (P=0.035).
Conclusions:
This study has provided the largest Japanese dataset for long-term follow-up of RA. Although RA in calcified lesions appears feasible with a high rate of procedural success, a high incidence of MACE was observed.