Key result
Rotational atherectomy-assisted PCI for heavily calcified coronary lesions achieved a 99.4% procedural success rate with a 1-year cumulative MACCE rate of 6.3%.
Why the study?
Evidence regarding the clinical outcomes of rotational atherectomy in middle-income countries was limited.
Cohort (n=616)
No
Rotational atherectomy-assisted PCI for heavily calcified lesions in a middle-income country setting demonstrates high success rates and acceptable 1-year MACCE rates, though periprocedural complications remain frequent.
Answers are grounded in this paper and cite their sources.
Supports rotational atherectomy feasibility for calcified lesions in middle-income settings; hypothesis-generating pending randomized comparisons.
Background: Evidence regarding the clinical outcomes of rotational atherectomy (RA) in middle-income countries is limited. We analyzed the clinical outcomes of patients with heavily calcified coronary lesions who underwent RA-assisted percutaneous coronary intervention (PCI) and explored the risks for developing major adverse cardiovascular and cerebrovascular events (MACCE). Methods: This is a single-center, retrospective cohort analysis that enrolled consecutive patients who underwent RA-assisted PCI at the largest tertiary hospital in Thailand. The primary endpoint is the incidence of MACCE during the first-year follow-up. MACCE consists of cardiac death, ischemic stroke, definite stent thrombosis, target lesion revascularization, and target vessel revascularization. Results: From January 2015 to December 2018, 616 patients (663 lesions) were enrolled. The mean age was 72.8 ± 9.7 years, 292 (47.4%) patients were female and 523 (84.9%) completed one-year follow-up. Drug-eluting stents were deployed in 606 (91.4%) lesions. The RA success rate - defined as when the operator successfully passed the burr across the target lesion - was 99.4% and the angiographic success rate was 94.8%. 130 (21.4%) procedures developed periprocedural complications. The cumulative MACCE rate at 30-days was 1.5% and at 1-year was 6.3%. The in-hospital mortality rate was 1.1% and the cardiac death rate was 1.6%. Independent risk factors for developing MACCE included the use of an intra-aortic balloon pump (hazard ratio [HR] 3.96, 95% confidence interval [CI] 1.54-10.21; P = 0.004), a history coronary artery bypass graft (HR 2.30, 95% CI 1.01-5.25; P = 0.048), and increased serum creatinine (HR 1.16, 95% CI 1.04-1.30; P = 0.008). Conclusions: RA is an effective revascularization technique for heavily calcified lesions. This study demonstrates a high success rate and good short- to intermediate-term results of RA-assisted PCI in middle-income countries which are similar to high-income countries. Nevertheless, the rate of periprocedural complications remains high.
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Towashiraporn et al. (2022) conducted a cohort in heavily calcified coronary lesions (n=616). Rotational atherectomy-assisted PCI was evaluated on Incidence of MACCE during the first-year follow-up. Rotational atherectomy-assisted PCI for heavily calcified coronary lesions achieved a 99.4% procedural success rate with a 1-year cumulative MACCE rate of 6.3%.
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