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Long-term clinical follow-up after directional coronary atherectomy
K S Grewal1, M B Jorgensen, J T Diesto
1Regional Cardiac Catheterization Laboratory, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
Insights
Directional coronary atherectomy (DCA) shows a 15.6% clinical restenosis rate at six months, with most patients remaining symptom-free long-term. This procedure offers a safe and effective option for treating coronary artery disease.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Directional coronary atherectomy (DCA) is established for safety and efficacy.
- Limited data exists on repeat revascularization needs solely based on symptom recurrence after DCA.
Purpose of the Study:
- To evaluate the need for repeat revascularization after DCA based on recurrent symptoms.
- To assess the long-term clinical outcomes and quality of life following DCA.
Main Methods:
- Retrospective analysis of clinical and angiographic data from 187 patients undergoing DCA.
- Lesion-specific approach used for eccentric, ulcerated, or irregular lesions in large epicardial vessels.
- Follow-up included assessment of recurrent angina, revascularization, and quality of life.
Main Results:
- DCA success rate was 96% with low in-hospital complications (3%).
- At 6 months, 15.6% of patients required revascularization for recurrent angina.
- Long-term follow-up showed 83% of patients were asymptomatic or had infrequent chest pain.
Conclusions:
- DCA is a safe and effective procedure with a low rate of in-hospital complications.
- The long-term clinical outcome is favorable, with a low rate of repeat revascularization needed.
- DCA improves quality of life for patients with refractory anginal symptoms.
Abstract:
Although several studies have been done to assess the safety, efficacy, and angiographic restenosis rates of directional coronary atherectomy (DCA), there have been no studies to document the need for repeat revascularization of the target vessel based purely on recurrence of symptoms. To answer this question, clinical and angiographic data were obtained for 187 consecutive patients undergoing this procedure on a native coronary artery utilizing a lesion specific approach in a referral hospital. Most of the patients had anginal symptoms that were not well controlled with medical therapy. The decision to perform DCA was based on the lesion characteristics (i.e., eccentric, ulcerated, or irregular discrete lesions in a large epicardial vessel). The procedure was successful in 96% of patients. In-hospital major complications were seen in 6 patients (3%) including acute myocardial infarction in 3 (1.5%) and emergency coronary artery bypass surgery in the other 3 (1.5%). There were no deaths. Among 141 consecutive successful patients on whom the procedure was performed between January 1992 and June 1994, 128 (91%) were contacted. At 6 months, revascularization was required in 20 patients for recurrent anginal symptoms, and there were no deaths or myocardial infarctions. The clinical restenosis rate, therefore, was 15.6%. At long-term follow-up (25 +/- 9 months), revascularization was performed in 3 more patients. One patient had a myocardial infarction and 3 patients died of noncardiac causes. Among those without clinical restenosis, 83% patients were asymptomatic and the rest had infrequent chest pains effectively managed with medications. The patients in the study group were using an average of 1.2 cardiac medications. Quality of life improved in 74% of the patients. Thus, in this study utilizing a lesion specific approach, the success rate for DCA was comparable to the published trials and in-hospital complications were few. The long-term clinical outcome was favorable with a low rate of clinical restenosis requiring repeat revascularization.