Sakakura Kenichi, Inohara Taku, Kohsaka Shun, Amano Tetsuya, Uemura Shiro, Ishii Hideki, Kadota Kazushige, Nakamura Masato, Funayama Hiroshi, Fujita Hideo, Momomura Shin-Ichi
From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.).
Circ Cardiovasc Interv. 2016 Nov;9(11). doi: 10.1161/CIRCINTERVENTIONS.116.004278.
The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI).
The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02-1.05), impaired kidney function (OR 1.59, 95% CI 1.15-2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21-2.35), emergent PCI (OR 4.02, 95% CI 1.66-8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43-3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36-0.89).
The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).
由于经皮冠状动脉介入治疗（PCI）的适应证扩展至更复杂的病变，目前在PCI中，旋磨术（RA）的使用正在增加。然而，RA后的并发症与手术相关的发病率和死亡率有关。本研究的目的是使用日本的一个大型全国注册系统（J-PCI）调查RA中并发症的发生率和决定因素。
本研究的主要复合结局定义为RA后院内死亡、心脏压塞和急诊手术的发生。共分析了13335例RA病例（占注册PCI病例的3.2%）。175例（1.31%）观察到复合结局，包括80例院内死亡（0.60%）、86例心脏压塞（0.64%）和24例急诊手术（0.18%）。与复合结局发生相关的临床变量包括年龄（每增加一个单位的比值比[OR]为1.03，95%置信区间[CI]为1.02-1.05）、肾功能受损（OR为1.59，95%CI为1.15-2.19）、既往心肌梗死（OR为1.69，95%CI为1.21-2.35）、急诊PCI（OR为4.02，95%CI为1.66-8.27）和三支血管病变（与单支血管病变相比：OR为2.17，95%CI为1.43-3.28）。值得注意的是，RA病例的机构手术量与复合结局呈负相关（高手术量机构与低手术量机构相比：OR为0.56，95%CI为0.36-0.89）。
在J-PCI中，报告的重要手术相关并发症发生率为1.3%，各组成部分在0.2%至0.6%之间。其决定因素既有患者相关因素（年龄、肾功能受损和既往心肌梗死），也有手术相关因素（急诊手术、病变血管数量和RA的机构手术量）。
