Allali Abdelhakim, Abdel-Wahab Mohamed, Sulimov Dmitriy S, Jose John, Geist Volker, Kassner Guido, Richardt Gert, Toelg Ralph
Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany.
J Interv Cardiol. 2017 Apr;30(2):124-133. doi: 10.1111/joic.12361. Epub 2016 Dec 19.
The aim of this study was to compare outcomes of bailout and planned rotational atherectomy (RA) in the treatment of calcified coronary lesions.
Current guidelines recommend RA as a bailout procedure for calcified or fibrotic lesions that cannot be adequately dilated before stenting. Nonetheless, planned RA is sometimes performed in certain challenging anatomies.
Data of patients treated with RA between 2002 and 2014 at a single-center registry were retrospectively analyzed. The bailout RA group included patients where RA was employed after failure of balloon dilatation or stent delivery. Planned RA included patients where RA was employed electively without previous device failure.
The study comprised 204 patients (221 lesions) and 308 patients (338 lesions) treated with bailout or planned RA, respectively. Angiographic success was achieved in the majority of cases, but was lower in the bailout RA group (93.7% vs. 97.6%, P = 0.02). Coronary dissections occurred more frequently in the bailout RA group (8.6% vs. 4.4%, P = 0.04), mean contrast amount was higher (279 ± 135 mL vs. 202 ± 92 mL, P < 0.001), and fluoroscopy time and procedural duration were longer in that group (32 min [IQR 21-51] vs. 18 min [IQR 14-28], P < 0.001 and 111 ± 50 min vs. 76 ± 35 min, P < 0.001, respectively). In-hospital death and myocardial infarction were not significantly different between the groups (2.9% vs. 1.3%, P = 0.21 and 6.9% vs. 4.2%, P = 0.19). In-hospital major adverse cardiac events (MACE) were higher in the bailout RA group (10.3% vs. 5.5%, P = 0.04). The 2-year estimated rates of MACE (25.2% vs. 28.7%, log rank P = 0.52) and its components death, myocardial infarction, and target vessel revascularization were not significantly different between the groups. Equivalence of 2-year MACE rates was also seen in all examined subgroups.
Shortened procedural duration and reduction of coronary dissections were observed with planned RA for selected lesions. However, this strategy does not affect long-term clinical outcomes.
本研究旨在比较补救性和计划性旋磨术（RA）治疗钙化冠状动脉病变的效果。
当前指南推荐RA作为补救措施，用于治疗支架置入前无法充分扩张的钙化或纤维化病变。尽管如此，在某些具有挑战性的解剖结构中有时会进行计划性RA。
回顾性分析2002年至2014年在单中心登记处接受RA治疗的患者数据。补救性RA组包括球囊扩张或支架置入失败后采用RA的患者。计划性RA组包括未发生先前器械故障而选择性采用RA的患者。
该研究分别包括204例患者（221处病变）和308例患者（338处病变）接受补救性或计划性RA治疗。大多数病例实现了血管造影成功，但补救性RA组的成功率较低（93.7%对97.6%，P = 0.02）。补救性RA组冠状动脉夹层更频繁发生（8.6%对4.4%，P = 0.04），平均造影剂用量更高（279±135 mL对202±92 mL，P < 0.001），该组透视时间和手术持续时间更长（32分钟[四分位间距21 - 51]对18分钟[四分位间距14 - 28]，P < 0.001；111±50分钟对76±35分钟，P < 0.001）。两组间住院死亡和心肌梗死无显著差异（2.9%对1.3%，P = 0.21；6.9%对4.2%，P = 0.19）。补救性RA组住院主要不良心脏事件（MACE）更高（10.3%对5.5%，P = 0.04）。两组间MACE的2年估计发生率（25.2%对28.7%，对数秩检验P = 0.52）及其组成部分死亡、心肌梗死和靶血管血运重建无显著差异。在所有检查的亚组中也观察到2年MACE发生率的等效性。
对于选定病变，计划性RA观察到手术持续时间缩短和冠状动脉夹层减少。然而，该策略不影响长期临床结局。
