TY - JOUR
T1 - Planned versus provisional rotational atherectomy for severe calcified coronary lesions
T2 - Insights From the ROTATE multi-center registry
AU - Kawamoto, Hiroyoshi
AU - Latib, Azeem
AU - Ruparelia, Neil
AU - Boccuzzi, Giacomo G.
AU - Pennacchi, Mauro
AU - Sardella, Gennaro
AU - Garbo, Roberto
AU - Meliga, Emanuele
AU - D'Ascenzo, Fabrizio
AU - Moretti, Claudio
AU - Rossi, Marco Luciano
AU - Presbitero, Patrizia
AU - Ielasi, Alfonso
AU - Magri, Caroline
AU - Nakamura, Sunao
AU - Colombo, Antonio
N1 - Publisher Copyright:
© 2016 Wiley Periodicals, Inc.
PY - 2016/11/15
Y1 - 2016/11/15
N2 - Objectives: We aimed to investigate procedural feasibility and outcomes associated with planned rotational atherectomy (RA) for severely calcified coronary lesions. Background: Limited data are available addressing the benefits of planned RA compared to provisional RA. Methods: Between 2002 and 2013, all patients with calcified lesions treated by RA were enrolled. Of these, patients treated with planned RA (358 patients) were compared to those treated with provisional RA (309 patients). Results: In-hospital major adverse cardiovascular events (MACE) were tended to be better in the planned RA group (unadjusted OR: 0.76; 95% CI: 0.44–1.31, P = 0.32, and adjusted OR: 0.59; 95% CI: 0.33–1.05, P = 0.07). The number of pre-dilation balloon catheters was significantly lower in the planned RA group (1.17 ± 0.60 vs. 1.47 ± 0.76, P < 0.001). Procedure time, fluoroscopy time, and contrast volume used were all significantly reduced in the planned RA group compared to the provisional RA group (procedure time; 65.2 ± 36.8min vs. 84.4 ± 43.1min, P < 0.001, fluoroscopy time; 33.1 ± 22.9min vs. 51.2 ± 29.6min, P < 0.001, and contrast volume; 232.9 ± 141.6ml vs. 302.9 ± 150.3ml, P < 0.001). The incidence of MACE at 1-year was significantly higher amongst the unadjusted population, whereas the difference was less marked between groups after propensity-score adjustment (unadjusted HR: 1.78; 95% CI: 1.16–2.74, P = 0.01, and adjusted HR: 1.44; 95% CI: 0.92–2.26, P = 0.11). Conclusions: Planned RA appears to be safe and was associated with a reduction in procedural and fluoroscopy times, contrast volume, and the number of pre-dilation balloon catheters used. If there is a strong likelihood of requiring RA for the treatment of severely calcified lesions, operators should have a low threshold for adopting a planned RA strategy.
AB - Objectives: We aimed to investigate procedural feasibility and outcomes associated with planned rotational atherectomy (RA) for severely calcified coronary lesions. Background: Limited data are available addressing the benefits of planned RA compared to provisional RA. Methods: Between 2002 and 2013, all patients with calcified lesions treated by RA were enrolled. Of these, patients treated with planned RA (358 patients) were compared to those treated with provisional RA (309 patients). Results: In-hospital major adverse cardiovascular events (MACE) were tended to be better in the planned RA group (unadjusted OR: 0.76; 95% CI: 0.44–1.31, P = 0.32, and adjusted OR: 0.59; 95% CI: 0.33–1.05, P = 0.07). The number of pre-dilation balloon catheters was significantly lower in the planned RA group (1.17 ± 0.60 vs. 1.47 ± 0.76, P < 0.001). Procedure time, fluoroscopy time, and contrast volume used were all significantly reduced in the planned RA group compared to the provisional RA group (procedure time; 65.2 ± 36.8min vs. 84.4 ± 43.1min, P < 0.001, fluoroscopy time; 33.1 ± 22.9min vs. 51.2 ± 29.6min, P < 0.001, and contrast volume; 232.9 ± 141.6ml vs. 302.9 ± 150.3ml, P < 0.001). The incidence of MACE at 1-year was significantly higher amongst the unadjusted population, whereas the difference was less marked between groups after propensity-score adjustment (unadjusted HR: 1.78; 95% CI: 1.16–2.74, P = 0.01, and adjusted HR: 1.44; 95% CI: 0.92–2.26, P = 0.11). Conclusions: Planned RA appears to be safe and was associated with a reduction in procedural and fluoroscopy times, contrast volume, and the number of pre-dilation balloon catheters used. If there is a strong likelihood of requiring RA for the treatment of severely calcified lesions, operators should have a low threshold for adopting a planned RA strategy.
KW - calcified lesions
KW - percutaneous coronary intervention
KW - rotational atherectomy
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U2 - 10.1002/ccd.26411
DO - 10.1002/ccd.26411
M3 - Article
C2 - 26775275
AN - SCOPUS:84955163913
SN - 1522-1946
VL - 88
SP - 881
EP - 889
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 6
ER -