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3-Year outcomes in patients with heavily calcified lesions undergoing percutaneous coronary intervention using
Wei Liu1,2, Yutong Yao1,2, Zhi Jiang3,4
1Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang, 550002, China.
Insights
Percutaneous coronary intervention (PCI) in heavily calcified lesions (HCLs) using cutting balloons (CBs) shows higher risks. Patients with HCLs treated with CBs experienced worse 3-year outcomes, including major adverse cardiac events and target vessel failure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) in heavily calcified lesions (HCLs) presents challenges, including increased complication rates and poorer patient prognosis.
- The efficacy and long-term outcomes of using cutting balloons (CBs) for HCLs require further clarification.
Purpose of the Study:
- To compare the 3-year clinical outcomes of patients with HCLs treated with CBs versus those with non-HCLs.
Main Methods:
- Retrospective analysis of 2432 patients undergoing PCI between June 2015 and September 2018.
- HCLs defined as radiopaque, high-pressure undilatable lesions; CBs used with non-compliant balloons.
- Propensity score matching used to compare outcomes (Major Adverse Cardiac Event - MACE, Target Vessel Failure - TVF) at 3-year follow-up.
Main Results:
- HCLs were present in 8.6% of patients, with a procedural success rate of 91.0%.
- Patients with HCLs exhibited a significantly higher incidence of MACE (23.3% vs. 10.8%, P < 0.001) compared to non-HCLs.
- Post-propensity score matching, HCL patients showed higher MACE (21.5% vs. 13.4%, P = 0.036) and TVF (19.8% vs. 9.9%, P = 0.008).
- HCL independently predicted increased risks of MACE (HR: 1.72), TVF (HR: 2.10), and repeat revascularization (HR: 2.20).
Conclusions:
- PCI using CBs in HCLs is associated with increased procedural complications and failure rates.
- Patients with HCLs treated with CBs demonstrate significantly worse 3-year clinical outcomes compared to those with non-HCLs.
- HCL is an independent risk factor for adverse cardiovascular events and repeat revascularization following PCI.
Background:
Percutaneous coronary intervention (PCI) of heavily calcified lesions (HCLs) is associated with higher complication rates and worse clinical outcomes. Cutting balloon (CB) has been widely used for HCLs, but patients' prognosis had not been fully clarified. The study aimed to compare 3-year clinical outcomes between patients with HCLs that are treated with CBs and those with non-HCLs.
Method:
Patients who underwent PCI in Guizhou Provincial People's Hospital from June 2015 to September 2018 were retrospectively included. HCL was defined as radiopaque and high-pressure undilatable lesions. CBs were routinely used in combination with non-compliant balloons for the HCLs. Major adverse cardiac event (MACE) and target vessel failure (TVF) were assessed at 3-year follow-up.
Result:
Among 2432 patients included in the study, 210(8.6%) had HCLs with a procedural success rate of 91.0%. The patients with HCLs had a higher incidence of MACE (23.3% vs. 10.8%, P < 0.001) than those with non-HCLs. By propensity score matching, 172 patients with HCLs were 1:1 paired to those with non-HCLs, and their PCI vessels were exactly matched. The MACE and TVF were significantly higher in the patients with HCLs than those with non-HCLs (MACE: 21.5% vs. 13.4%, P = 0.036; TVF: 19.8% vs. 9.9%, P = 0.008). In the Cox regression analysis, HCL is independently associated with higher risks of MACE [HR: 1.72(1.01-2.94), P = 0.047], TVF [HR: 2.10(1.15-3.81), P = 0.015] and repeat revascularization [HR: 2.20(1.07-4.52), P = 0.032].
Conclusion:
Patients with HCLs undergoing PCI using CBs in combination with non-compliant balloons had higher risks of complications, procedural failure, and worse clinical outcomes at 3 years than those with non-HCLs.
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