Key result
Adjunctive coronary atherectomy during PCI for calcified lesions was associated with a 38% decrease in the odds of procedural complications (P=0.005), with similar 2-year mortality.
Why the study?
Does adjunctive coronary atherectomy reduce procedural complications in patients undergoing single-vessel PCI for naïve native calcific coronary lesions?
Cohort (n=9,719)
Yes
Does adjunctive coronary atherectomy reduce procedural complications in patients undergoing single-vessel PCI for naïve native calcific coronary lesions?
Odds Ratio: 0.62
p-value: p=0.005
Adjunctive coronary atherectomy during PCI for calcified lesions is associated with reduced procedural and clinical complications, though 2-year hard clinical outcomes remain similar to PCI without atherectomy.
Adjunctive atherectomy was associated with fewer procedural complications in calcified PCI; leaves open need for randomized trials on long-term outcomes.
OBJECTIVES: We sought to evaluate the prevalence of calcified coronary lesions and the association between the use of atherectomy and clinical outcomes. BACKGROUND: Calcified coronary arteries are associated with an increased risk of procedural complications during percutaneous coronary intervention (PCI). The outcomes of coronary atherectomy for adjunctive treatment of calcified coronary lesions are not well described. METHODS: We identified all patients treated for calcified coronary lesions at VA hospitals. A propensity weighted cohort was created for those treated with or without adjunctive atherectomy to evaluate the complications and outcomes between groups. RESULTS: From 2007 to 2015, 9,719 patients underwent single-vessel PCI for treatment of naïve native calcific coronary lesions. The proportion of patients undergoing revascularization of calcified lesions increased over the study period (P = 0.03) and 1,731 patients (18%) were treated with atherectomy. Adjunctive atherectomy was more likely to be used in high-risk lesions (76.5% vs. 46.8%, P < 0.001). After propensity weighting, coronary atherectomy was associated with a 38% decrease in the odds of procedural complications and a 54% decrease in the odds of clinical complications (both P = 0.005). There was no difference in rates of 2-year death (HR: 1.07; 95% CI: 0.92-1.24), myocardial infarction (HR: 0.96; 95% CI: 0.75-1.23) or target vessel revascularization (HR: 0.96; 95% CI: 0.78-1.19) CONCLUSIONS: Percutaneous treatment of calcified coronary lesions has increased over time. The adjunctive use of coronary atherectomy was associated with a reduction in procedural complications among patients with calcified coronary arteries. Two-year TVR, MI and overall mortality were similar between the two groups.
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Armstrong et al. (2017) conducted a cohort in calcified coronary lesions (n=9,719). Adjunctive coronary atherectomy vs. PCI without adjunctive atherectomy was evaluated on procedural complications (38% decrease in odds, p=0.005). Adjunctive coronary atherectomy during PCI for calcified lesions was associated with a 38% decrease in the odds of procedural complications (P=0.005), with similar 2-year mortality.
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