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Comparison of outcomes in patients undergoing rotational atherectomy after unsuccessful coronary angioplasty versus elective rotational atherectomy

Session Poster session 1

Speaker Associate Professor Marek Gierlotka

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : JT Gorol (Zabrze,PL), M Tajstra (Zabrze,PL), K Wilczek (Zabrze,PL), B Hudzik (Zabrze,PL), R Regula (Zabrze,PL), J Piegza (Zabrze,PL), J Szkodzinski (Zabrze,PL), M Gierlotka (Zabrze,PL), A Lekston (Zabrze,PL), M Gasior (Zabrze,PL)

Authors:
J.T. Gorol1 , M. Tajstra1 , K. Wilczek1 , B. Hudzik1 , R. Regula1 , J. Piegza1 , J. Szkodzinski1 , M. Gierlotka1 , A. Lekston1 , M. Gasior1 , 1Silesian Center for Heart Diseases (SCHD), 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical U - Zabrze - Poland ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 199

Introduction: Revascularization of patients with heavily calcified coronary arteries can be a challenge for interventional cardiologists. Calcified lesions often create problems during PCI and require the use of more aggressive techniques, typically associated with a greater risk of complications. The procedural success rate in these patients can be improved by using rotational atherectomy (RA), which is a technique to modify the atherosclerotic plaque and facilitate stent delivery and implantation.

Purpose: The aim of this study was to compare clinical characteristics and outcomes during hospitalization and at 12-month follow-up between patients who underwent RA as a bailout procedure secondary to failed conventional angioplasty or as an elective procedure.

Methods: This is a retrospective analysis of 156 consecutive patients hospitalized at a high-volume PCI center between 2009 and 2016 who underwent RA. In 113 patients (72.4%) designated as group 1, RA was carried out after unsuccessful traditional angioplasty (inability to cross the lesion with a balloon, balloon underexpansion). In 43 patients (27.6%) designated as group 2, RA was performed on an elective basis.

Before and after the procedure, quantitative coronary angiography of the treated lesions was performed by two independent interventional cardiologists. Procedural success was defined as successful stent implantation with stenosis of less than 20% diameter and TIMI-3 flow. The primary endpoint was in-hospital and 12-month all-cause mortality. Secondary endpoints included myocardial infarction (MI), the need for repeat target vessel revascularization (TVR) or revascularization of the treated lesion (TLR), stroke, and all major adverse cardiovascular and cerebrovascular events (MACCE) which consisted of death, MI, TVR, TLR, and stroke.

Results: Patients in the two groups did not differ with regard to sex, age, or cardiovascular risk factors. Patients in group 1 more often had a history of previous coronary interventions (74.3% vs 51.1%; p=0.05). Group 2 was dominated by patients with multivessel disease (33.6% vs 62.8%; p<0.001). Left main was more often treated in group 2 (2,7% vs 25,6%; p<0.001). The success rates in the two groups were similar: 91.2% for group 1 and 93.0% in group 2 (p=0.70). The rate of in-hospital complications did not significantly differ between groups. There was one in-hospital death in group 2. During the 12-month follow-up, MI occurred in 7.1% of patients in group 1 and 4.7% of patients in group 2 (p=0.58), TLR occurred in 5.3% and 2.3%, respectively (p=0.42), and TVR occurred in 7.1% and 4.7%, respectively (p=0.58) There was no difference in the 12-month survival rate (91.2% in group 1 vs 86.1%, p=0.35) and MACCE (15.0% vs 16.3%; p=0,85).

Conclusions: RA treatment is associated with high efficacy and a relatively low risk of complications, with no significant differences in outcomes between patients treated with primary and secondary RA procedures.

12-month survival rate

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