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Published on: September 22, 2020
Prognostic value of angiography-derived microcirculatory resistance in patients undergoing rotational atherectomy- a
Xi Zhang1, Qing Jin1, Chenguang Li2
1Department of Cardiology, Yan'an Hospital of Kunming City, Yan'an Hospital Affiliated To Kunming Medical University, 650051 Kunming, China; Kunming Cardiovascular Interventional Imaging Institute, 650051 Kunming, China.
Insights
Rotational atherectomy (RA) can lead to coronary microvascular dysfunction (CMD). Post-RA CMD, indicated by AMR ≥2.5, predicts major adverse cardiovascular events (MACE) in patients with coronary atherosclerotic heart disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Rotational atherectomy (RA) treats calcified coronary lesions in coronary atherosclerotic heart disease (CAD).
- Postoperative coronary microvascular dysfunction (CMD) and its prognostic implications after RA are understudied.
- Assessing CMD and major adverse cardiovascular events (MACE) post-RA is crucial for patient outcomes.
Purpose of the Study:
- To investigate the predictive value of post-RA microvascular dysfunction for MACE.
- To identify risk factors associated with CMD following RA.
- To evaluate the relationship between RA procedural characteristics and CMD development.
Main Methods:
- Retrospective, multicenter study of 532 patients undergoing RA (Jan 2019 - Nov 2022).
- Coronary microcirculatory function assessed by angiography-derived microcirculatory resistance (AMR).
- Patients categorized into CMD (AMR ≥2.5 mm Hg·s/cm) and non-CMD groups; followed for MACE.
Main Results:
- Post-RA, mean AMR and CMD prevalence increased significantly (p < 0.001).
- 143 patients (26.9%) developed CMD (AMR ≥2.5).
- MACE occurred in 22.0% of patients over 18 months; higher in CMD group (32.1% vs 18.2%, p < 0.001).
- AMR ≥2.5 (HR=2.01), EF, and renal insufficiency independently predicted MACE.
- RA operative length and diabetes mellitus (DM) associated with post-RA CMD.
Conclusions:
- Longer RA operative length and diabetes mellitus are linked to CMD post-procedure.
- Post-RA AMR ≥2.5 mm Hg·s/cm is an independent predictor of MACE.
- These findings highlight the importance of assessing microvascular function after RA.
Background:
Rotational atherectomy (RA) is predominantly performed to treat severely calcified lesions in patients with coronary atherosclerotic heart disease (CAD). Studies focusing on the assessment of postoperative coronary microvascular dysfunction (CMD) after RA and related prognosis are scarce.
Aims:
We investigated the predictive risks of microvascular dysfunction and postoperative major adverse cardiovascular events (MACE) in patients after RA.
Methods:
This retrospective and multicenter study analyzed the data from patients after RA between January 2019 and November 2022. The coronary microcirculatory function after RA was assessed using angiography-derived microcirculatory resistance (AMR). Patients were categorized into CMD and non-CMD groups depending on a postoperative AMR of ≥2.5 mm Hg-s/cm. Patients were followed up for MACE.
Results:
We analyzed data from 532 patients; after RA, the mean AMR, mean QFR, and percentage of CMDs were significantly higher as compared prior to RA (p < 0.001). A total of 143 (26.9 %) patients had AMR ≥2.5 after the procedure. MACE occurred in 117 (22.0 %) patients after 18 months of follow-up. The proportion of patients with MACE was higher in the AMR ≥ 2.5 than in the AMR < 2.5 (32.1 % vs. 18.2 %, p < 0.001) group. Cox regression analysis showed that AMR ≥2.5 mm Hg-s/cm (HR = 2.01, 95 % CI: 1.39-2.92, p < 0.001), EF and renal insufficiency were independent predictors of MACE. Logistic regression analyses revealed that the length of the RA operative area and presence of diabetes mellitus (DM) were related to post-RA CMD.
Conclusions:
The operative length of RA and DM were associated with CMD after RA; furthermore, post-RA AMR ≥2.5 mm Hg-s/cm independently predicted post-RA MACE.
