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Published on: February 26, 2013
Long-Term Outcomes Following Percutaneous Coronary Intervention With Rotational Atherectomy for Severely Calcified
Mikako Kise1, Takayuki Ishihara1, Naoko Higashino2
1Kansai Rosai Hospital Cardiovascular Center Hyogo Japan.
Insights
Long-term outcomes after percutaneous coronary intervention with rotational atherectomy show a 6-year target vessel failure rate over 30%. Hemodialysis and diabetes significantly impact these outcomes, necessitating careful patient selection for this procedure.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Severe arterial calcification poses challenges in percutaneous coronary intervention (PCI).
- Rotational atherectomy (RA) is utilized for lesion modification in calcified coronary arteries.
- Long-term outcomes following PCI with RA remain incompletely understood.
Purpose of the Study:
- To investigate the long-term clinical outcomes of patients undergoing PCI with RA for severely calcified lesions.
- To identify predictors of adverse events after PCI with RA.
Main Methods:
- A cohort of 301 patients with 334 lesions treated with PCI and RA was analyzed.
- Primary endpoint: target vessel failure (TVF) - cardiac death, target vessel MI, target vessel revascularization.
- Secondary endpoint: major adverse cardiac event (MACE). Cox regression analysis was used to identify predictors.
Main Results:
- The 6-year cumulative incidence of TVF was 32.5%.
- The 6-year cumulative incidence of MACE was 32.9%.
- Independent predictors for TVF included hemodialysis (HR 3.22) and diabetes (HR 2.10).
Conclusions:
- PCI with RA in severely calcified lesions is associated with a substantial long-term TVF rate exceeding 30% at 6 years.
- Hemodialysis and diabetes are significant independent predictors of long-term TVF.
- Careful consideration of PCI with RA is warranted in patients with severely calcified lesions, particularly those with hemodialysis and diabetes.
Background:
While severe calcification is associated with unfavorable clinical outcomes, rotational atherectomy (RA) has been used for lesion modification of severely calcified lesions. However, long-term outcomes after percutaneous coronary intervention (PCI) with RA have not yet been fully investigated.
Methods And Results:
We enrolled 301 patients with 334 lesions, which were treated using PCI with RA. The primary outcome was target vessel failure (TVF) defined as a composite of cardiac death (CD), target vessel myocardial infarction (MI), and target vessel revascularization (TVR). The secondary outcome was a major adverse cardiac event (MACE), defined as a composite of CD, MI, TVR, and definite stent thrombosis (ST). In addition, the predictors of TVF were evaluated using Cox proportional hazards regression analysis. The mean follow-up duration was 36.6±27.0 months. The cumulative incidence rates of TVF were 20.6%, 29.1%, and 32.5% at 2, 4, and 6 years, respectively. The 6-year cumulative incidence of MACE was 32.9%. The independent predictors of TVF were hemodialysis (hazard ratio 3.22 [95% confidential interval 1.91-5.43]) and diabetes (2.10 [1.24-3.57]).
Conclusions:
The 6-year TVF rate after RA reached over 30%. Hemodialysis and diabetes significantly impacted the long-term outcome. The strategy of PCI with RA should be carefully selected for severely calcified lesions in patients with hemodialysis and diabetes.
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