Division of Cardiology, Saint Mary's Hospital, 160 Zhongzheng South Road, Luodong, Yilan 26546, Taiwan, China.
J Geriatr Cardiol. 2013 Sep;10(3):217-25. doi: 10.3969/j.issn.1671-5411.2013.03.009.
Heavily calcified left-main coronary diseases (LMCA) remain a formidable challenge for percutaneous interventions (PCI). This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions in actual practice.
From February 2004 to March 2012, all consecutive patients who received RA for heavily-calcified LMCA lesions in our cath lab were enrolled. The relevant clinical and angiographic characteristics at the time of index PCI, as well as the clinical follow-up outcomes, were retrieved and analyzed.
A total of 34 consecutive patients were recruited with a mean age 77.2 ± 10.2 years. There were 82.4% presented with acute coronary syndrome and 11.8% with cardiogenic shock. Chronic renal disease and diabetes were seen in 64.7% and 52.9%, respectively. Triple-vessel coronary disease was found in 76.5% of them. The mean SYNTAX score was 50 ± 15 and EuroSCORE II scale 5.6 ± 4.8. The angiographic success rate was 100% with a procedural success rate of 91.2%. The mean number of burrs per patient was 1.7 ± 0.5. Crossing-over stenting was used in 64.7%. Most stents were drug-eluting (67.6%). Intra-aortic ballon pump was used in 20.6% of the procedures. Three patients died during hospitalization, all due to presenting cardiogenic shock. No major complication occurred. Among 31 hospital survivors, the major adverse cardiac events (MACE) rate was 16.1%, all due to target lesion revascularization or target vessel revascularization.
In high-surgical-risk elderly patients, plaque modification with RA in PCI of heavily-calcified LMCA could be safely accomplished with a minimal complication rate and low out-of-hospital MACE.
严重钙化的左主干冠状动脉疾病（LMCA）仍然是经皮介入治疗（PCI）的一大挑战。本研究旨在探讨在实际实践中使用旋磨术（RA）治疗此类病变的安全性和有效性。
从 2004 年 2 月至 2012 年 3 月，我们的导管室连续收治了所有因严重钙化的 LMCA 病变而行 RA 的患者。回顾并分析了指数 PCI 时的相关临床和血管造影特征，以及临床随访结果。
共纳入 34 例连续患者，平均年龄 77.2 ± 10.2 岁。82.4%为急性冠状动脉综合征，11.8%为心源性休克。慢性肾病和糖尿病分别占 64.7%和 52.9%。三血管病变占 76.5%。平均 SYNTAX 评分 50 ± 15，EuroSCORE II 评分 5.6 ± 4.8。血管造影成功率为 100%，手术成功率为 91.2%。每位患者的磨头数平均为 1.7 ± 0.5。交叉支架植入术使用率为 64.7%。大多数支架为药物洗脱支架（67.6%）。术中使用主动脉内球囊泵的占 20.6%。3 例患者在住院期间死亡，均因心源性休克。无重大并发症发生。31 例住院存活患者中，主要不良心脏事件（MACE）发生率为 16.1%，均为靶病变血运重建或靶血管血运重建所致。
在高手术风险的老年患者中，经皮 PCI 中使用 RA 进行斑块修饰可安全完成，并发症发生率低，院外 MACE 发生率低。
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