Key result
In patients undergoing rotational atherectomy for heavily calcified coronary lesions, the 5-year cumulative incidence of MACE was 46.7%, with hemodialysis and age identified as strong independent predictors.
Cohort (n=1,090)
Yes
Rotational atherectomy for heavily calcified coronary lesions is feasible with high procedural success, but is associated with a high long-term incidence of major adverse cardiac events, particularly in older patients and those on hemodialysis.
Answers are grounded in this paper and cite their sources.
High long-term MACE after rotational atherectomy warrants caution in older and hemodialysis patients; leaves open whether alternative strategies improve outcomes.
BACKGROUND: Rotational atherectomy (RA) is an adjunct tool for the management of heavily calcified coronary lesions during percutaneous coronary intervention (PCI), but the long-term clinical outcomes of RA use remain unclear in this drug-eluting stent era. METHODS AND RESULTS: This multi-center registry assessed the characteristics and outcomes of patients treated by RA for calcified coronary lesions between 2004 and 2015. Among 1,090 registered patients, mean age was 70±10 years and 815 (75%) were male. Sixty percent of patients had diabetes mellitus and 27.7% were receiving hemodialysis. The procedure was successful in 96.2%. In-hospital death occurred in 33 patients (3.0%), and 14 patients (1.3%) developed definite/probable stent thrombosis. During the median follow-up period of 3.8 years, the incidence of major adverse cardiac events (MACE), defined as all-cause death, acute coronary syndrome, stent thrombosis, target vessel revascularization and stroke, was 46.7%. On multivariable Cox hazard analysis, hemodialysis (HR, 2.08; 95% CI: 1.53-2.86; P<0.0001) and age (HR, 1.03; 95% CI: 1.01-1.04; P<0.0001) were strong independent predictors of MACE. Conversely, statin treatment was associated with lower incidence of MACE (P=0.035). CONCLUSIONS: This study has provided the largest Japanese dataset for long-term follow-up of RA. Although RA in calcified lesions appears feasible with a high rate of procedural success, a high incidence of MACE was observed.
No takes yet. Share an insight, caveat, or question.
Okai et al. (2017) conducted a cohort in Heavily calcified coronary lesions (n=1,090). Rotational atherectomy (RA) was evaluated on Major adverse cardiac events (MACE), defined as all-cause death, acute coronary syndrome, stent thrombosis, stroke or target vessel revascularization. In patients undergoing rotational atherectomy for heavily calcified coronary lesions, the 5-year cumulative incidence of MACE was 46.7%, with hemodialysis and age identified as strong independent predictors.
Synapse has enriched 10 related papers. Consider them for comparative context: