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Hong XL, Li Y, Zhou BQ, Fu GS, Zhang WB. Comparison of rotational atherectomy and modified balloons prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions. Medicine (Baltimore) 2021; 100:e25323. [PMID: 33761735 PMCID: PMC9281966 DOI: 10.1097/md.0000000000025323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
The optimal strategy for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation remains debatable. This study sought to compare the performance of rotational atherectomy (RA) and modified balloon (MB)-based strategy in patients with HCCL receiving current-generation DES.This retrospective study comprised 564 consecutive patients who underwent RA (n = 229) or MB (n = 335) for HCCL at our hospital and were treated with DES. Baseline clinical and angiographic data was obtained from our database. Patients were clinically monitored for the occurrence of any adverse events during the hospitalization. One-year follow-up was conducted by either telephone contact or outpatient visits. 1:1 propensity score matching (PSM) was performed to balance the baseline covariates. After PSM, the clinical outcomes between the 2 groups were compared.After PSM, except more target lesion in right coronary artery existing in the RA group (P = .008), no significant statistical differences were shown in regard of the other angiographic and procedural characteristics of the 2 groups. Strategy success rates were all 100% in both groups. In the unadjusted Cox proportional hazard analysis, participants with RA had a significantly lower risk of target lesion revascularization (TLR) (hazard ratio, HR 0.275, 95% confidence intervals, CI 0.119-0.635, P = .003) and major adverse cardiac event (MACE) (HR 0.488, 95% 0.277-0.859, P = .013). After adjusting for potential confounding variables, RA was significantly associated with TLR (HR 0.32, 95% 0.12-0.853, P = .023), but no longer significantly associated with MACE (HR 0.674, 95% 0.329-1.381, P = .282).In patients with HCCL, lesion preparation with RA was safe and could improve strategy success rate. There was lower rate of TLR with RA, however, no significant difference was found in the MACE rate at 1-year follow-up between RA and MB-based strategy.
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Affiliation(s)
- Xu-Lin Hong
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Ya Li
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Bin-Quan Zhou
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Guo-Sheng Fu
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
| | - Wen-Bin Zhang
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province
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Zhang HP, Zhao Y, Ai H, Li H, Tang GD, Zheng NX, Sun FC. Outcomes of coronary rotational atherectomy in patients with reduced left ventricular ejection fraction. J Int Med Res 2019; 48:300060519895144. [PMID: 31878815 PMCID: PMC7783247 DOI: 10.1177/0300060519895144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective We evaluated the safety and efficacy of rotational atherectomy (RA) in
patients with a reduced left ventricular ejection fraction (LVEF). Methods In total, 140 consecutive patients with severe coronary artery calcification
(CAC) who underwent RA were retrospectively enrolled. Patients were grouped
based on LVEF: ≤35% (n = 10), 36% to 50% (n = 11), and >50% (n = 119). We
assessed procedural success and periprocedural complication rates as well as
the incidences of in-hospital and 2-year major adverse cardiac events
(MACEs), defined as hospitalization for myocardial infarction and worsening
heart failure, target vessel revascularization, and cardiac death. Results Procedural success was achieved in nearly all patients in each group. Most
periprocedural complications were minor, and major complications were
uncommon. The 2-year MACE rate was significantly higher in the LVEF ≤35%
than LVEF >50% group (40.0% vs. 6.7%, respectively). Multivariable
regression analysis revealed that the LVEF was the only independent
predictor of 2-year MACEs in patients who underwent RA. Conclusions Patients with a reduced LVEF who underwent RA had procedural success rates
similar to those of patients with preserved left ventricular systolic
function. The LVEF might be an independent predictor of 2-year MACEs in
patients with severe CAC after percutaneous coronary intervention following
RA.
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Affiliation(s)
- Hui-Ping Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Ying Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Hu Ai
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Guo-Dong Tang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Nai-Xin Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
| | - Fu-Cheng Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China
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Kotronias RA, Scarsini R, Gibbs T, De Maria GL, Rajasundaram S, Langrish JP, Lucking AJ, Channon KM, Kharbanda RK, Banning AP. Safety of Rotational Atherectomy Using the Radial Access in Patients With Severe Aortic Stenosis. Am J Cardiol 2019; 124:381-388. [PMID: 31174836 DOI: 10.1016/j.amjcard.2019.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 01/22/2023]
Abstract
Despite frequent percutaneous coronary intervention (PCI) in calcified vessels of older patients, rotational atherectomy (RA) has not been endorsed in patients with severe aortic stenosis (AS) due to safety concerns and lack of data. We explored periprocedural safety and mortality in severe AS patients undergoing RA. Prospective anonymized clinical, echocardiographic, procedural and outcome data of patients undergoing RA PCI between January 2012 and July 2018 were retrospectively extracted from the institutional coronary database. Patients with severe AS undergoing RA PCI were 1:1 propensity matched with patients undergoing RA PCI in the absence of AS. Outcomes of interest were RA related periprocedural complications, 30-day and 1-year mortality. A prespecified subgroup analysis examined the influence of transcatheter aortic valve replacement on mortality following RA PCI. A total of 544 patients underwent RA PCI; 478 without AS and 66 with AS. Propensity matching yielded 35 matched pairs with improved balance in covariates of interest and no significant differences in baseline characteristics postmatching. In the matched cohort (n = 70) slow flow/no-reflow, coronary dissection, perforation, and hemodynamic instability were rare and not significantly different. Survival analyses revealed significantly higher 30-day (Log-Rank p = 0.02) and 1-year mortality (Log rank p = 0.02, HR 5.24 [95% CI 1.13 to 24.28]) in the severe AS group; driven by a fivefold increase in the hazard of death among patients who did not undergo transcatheter aortic valve replacement HR 4.98 [95% CI 1.03 to 24.1]. In conclusion, our study of 70 patients undergoing radial RA PCI suggests that it can be safely performed in patients with severe AS. Long-term outcomes after RA in patients with severe AS are determined by the presence of the valve disease and other co-morbidities.
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Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study. Cardiol Ther 2019; 8:267-281. [PMID: 31350729 PMCID: PMC6828855 DOI: 10.1007/s40119-019-0143-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Rotational atherectomy (RA) historically was contraindicated in patients with impaired left ventricular (LV) function due to inherent cardio-depressive effects. Contemporary RA practice is less aggressive than traditional RA and no longer withheld from patients with reduced ejection fraction (EF). The aim of this analysis is to explore the outcomes of rotational atherectomy (RA) in patients with reduced left ventricular ejection fraction (LVEF). Methods Patients undergoing RA (n = 644) were divided into three groups according to LVEF (severely reduced ≤ 35%, n = 82; moderately reduced 36–54%, n = 170; and preserved LVEF ≥ 55%, n = 392). Results Compared to patients with preserved LVEF, those with severely reduced LVEF had higher rates of angiographic failure (12.2 vs. 3.3%, p = 0.003) and in-hospital major adverse cardiac events (MACE: 9.8 vs. 2.3%, p = 0.004) driven by more peri-procedural myocardial infarction (MI: 6.1 vs. 1.5%, p = 0.049). In-hospital outcomes were similar between patients with preserved and moderately reduced LVEF. At 5-year follow-up, a stepwise increase in all-cause death was observed with lower LVEF (preserved: 15%, moderately reduced: 23%, severely reduced: 43%; p < 0.001). On the other hand, revascularization and MI rates at 5 years were not affected by LVEF. Conclusions Compared to patients with preserved LVEF, those with severely reduced LVEF have worse acute outcomes after RA, whereas a moderate reduction of LVEF poses no additional acute hazard after RA. Up to 5 years, the extent of left ventricular dysfunction was associated with a stepwise increase in mortality. Electronic supplementary material The online version of this article (10.1007/s40119-019-0143-4) contains supplementary material, which is available to authorized users.
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Abstract
Successful percutaneous coronary intervention (PCI) can be challenging in the presence of heavily calcified lesions. Severely calcified lesions are associated with worse clinical outcomes. Recognition of calcification is important before stenting to ensure adequate stent expansion can be attained. Orbital atherectomy is a safe and effective method to ablate calcified plaque. Lesion preparation through plaque modification with orbital atherectomy before stent implantation can help to optimize the results of PCI in these complex lesions.
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Affiliation(s)
- Evan Shlofmitz
- MedStar Washington Hospital Center, 110 Irving Street, Suite 4B1, Washington, DC 20010, USA
| | - Richard Shlofmitz
- St. Francis Hospital- The Heart Center, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA
| | - Michael S Lee
- UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA.
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Abdel-Wahab M, Toelg R, Byrne RA, Geist V, El-Mawardy M, Allali A, Rheude T, Robinson DR, Abdelghani M, Sulimov DS, Kastrati A, Richardt G. High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions. Circ Cardiovasc Interv 2018; 11:e007415. [DOI: 10.1161/circinterventions.118.007415] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
- Department of Cardiology, Heart Center Leipzig, Leipzig University Hospital, Germany (M.A.-W., D.S.S.)
| | - Ralph Toelg
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Robert A. Byrne
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Germany (R.A.B., A.K.)
| | - Volker Geist
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Mohamed El-Mawardy
- Department of Cardiology, Vivantes Wenckebach Hospital, Berlin, Germany (M.E.-M.)
| | - Abdelhakim Allali
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Tobias Rheude
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
| | - Derek R. Robinson
- Department of Mathematics, University of Sussex, Brighton, United Kingdom (D.R.R.)
| | - Mohammad Abdelghani
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
| | - Dmitriy S. Sulimov
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
- Department of Cardiology, Heart Center Leipzig, Leipzig University Hospital, Germany (M.A.-W., D.S.S.)
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (R.A.B., T.R., A.K.)
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Germany (R.A.B., A.K.)
| | - Gert Richardt
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany (M.A.-W., R.T., V.G., A.A., M.A., D.S.S., G.R.)
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Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018. [DOI: 10.1016/j.carrev.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shlofmitz E, Martinsen BJ, Lee M, Rao SV, Généreux P, Higgins J, Chambers JW, Kirtane AJ, Brilakis ES, Kandzari DE, Sharma SK, Shlofmitz R. Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices. Expert Rev Med Devices 2017; 14:867-879. [DOI: 10.1080/17434440.2017.1384695] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Evan Shlofmitz
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Brad J. Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Michael Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Morristown, NJ, USA
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Joe Higgins
- Department of Engineering, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Jeffrey W. Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, MN, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Samin K. Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, NY, USA
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Chronic Total Occlusions. JACC Cardiovasc Interv 2017; 10:889-891. [DOI: 10.1016/j.jcin.2017.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 11/21/2022]
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