Intravascular Imaging Guidance Reduce 1-Year MACE in Patients Undergoing Rotablator Atherectomy-Assisted Drug-Eluting
Nattawut Wongpraparut1, Paroj Bakoh1, Kawin Anusonadisai1
1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Intravascular imaging guidance significantly reduced 1-year major adverse cardiac events (MACE) in patients undergoing rotablator atherectomy-assisted percutaneous coronary intervention with drug-eluting stent implantation. This approach also lowered rates of death, myocardial infarction, and target vessel revascularization compared to standard angiographic guidance.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a common treatment for coronary artery disease.
- Rotablation atherectomy (RA) is used for heavily calcified lesions, posing technical challenges.
- Optimal guidance strategies for RA-assisted PCI with DES are crucial for patient outcomes.
Purpose of the Study:
- To compare the 1-year incidence of major adverse cardiac events (MACE) between intravascular imaging guidance and angiographic guidance.
- To evaluate the effectiveness of intravascular imaging in patients undergoing RA-assisted PCI with DES implantation.
- To identify specific components of MACE that are influenced by imaging guidance.
Main Methods:
- Retrospective analysis of 265 consecutive patients with heavy calcified lesions undergoing RA-assisted PCI with DES.
- Patients were divided into two groups: intravascular imaging guidance (intravascular ultrasound or optical coherence tomography) and angiographic guidance.
- Primary endpoint was the 1-year incidence of MACE.
Main Results:
- One-year MACE was significantly lower in the imaging guidance group (4.3%) compared to the angiographic guidance group (28.9%).
- Intravascular imaging guidance was associated with significantly lower rates of all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR) at 1 year.
- No significant difference in stroke rates was observed between the groups.
Conclusions:
- Intravascular imaging guidance significantly reduces 1-year MACE in patients with heavy calcified lesions undergoing RA-assisted DES implantation.
- The use of intravascular imaging improves outcomes by decreasing the incidence of death, MI, and TVR.
- Intravascular imaging should be considered for guiding complex PCI procedures involving heavily calcified lesions.
Abstract:
Objectives: This study aimed to investigate the incidence of 1-year major adverse cardiac events (MACE) compared between intravascular imaging guidance and angiographic guidance in patients undergoing rotablator atherectomy (RA)-assisted percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Methods: This retrospective analysis included 265 consecutive patients with heavy calcified lesion who underwent RA-assisted PCI with DES implantation at our institution during the January 2016-December 2018 study period. This study was approved by the Siriraj Institutional Review Board. Patients were divided into either the angiographic guidance PCI group or the imaging guidance PCI group, which was defined as intravascular ultrasound or optical coherence tomography. The primary endpoint was 1-year MACE. Results: Two hundred and sixty-five patients were enrolled, including 188 patients in the intravascular imaging guidance group, and 77 patients in the angiographic guidance group. One-year MACE was significantly lower in the imaging guidance group compared to the angiographic guidance group (4.3 vs. 28.9%, respectively; odds ratio (OR): 9.06, 95% CI: 3.82-21.52; p < 0.001). The 1-year rates of all-cause death (OR: 8.19, 95% CI: 2.15-31.18; p = 0.002), myocardial infarction (MI) (OR: 6.13, 95% CI: 2.05-18.3; p = 0.001), and target vessel revascularization (TVR) (OR: 3.67, 95% CI: 1.13-11.96; p = 0.031) were also significantly lower in the imaging guidance group compared with the angiographic guidance group. The rate of stroke was non-significantly different between groups. Conclusion: In patients with heavy calcified lesion undergoing RA-assisted DES implantation, the intravascular imaging guidance significantly reduced the incidence of 1-year MACE, all-cause death, MI, and TVR compared to the angiographic guidance.
