Bartuś Stanisław, Januszek Rafał, Legutko Jacek, Rzeszutko Łukasz, Dziewierz Artur, Dudek Dariusz
2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland, Poland.
Kardiol Pol. 2017;75(6):564-572. doi: 10.5603/KP.a2017.0042.
Rotational atherectomy (RA) plays a significant role in contemporary percutaneous coronary interventions (PCI), especially in the era of population aging and expansion of PCI indications.
The aim of the current study was to evaluate the rate of periprocedural complications, the long-term effectiveness of RA, and potential factors influencing the incidence of major adverse cardiac events (MACE) and major cardiac as well as cerebrovascular events (MACCE) after RA.
The study included 60 consecutive patients who underwent effective RA between January 2002 and May 2016. Patients were followed-up for 2,616 days for MACE and MACCE.
The mean age of the enrolled patients was 72.1 years, and 78.3% were males. The mean follow-up period lasted 835.3 ± 611.8 days. Periprocedural complications occurred in 12 (20.0%) patients. In the follow-up of up to 2,616 days, 64% of patients were free of MACCE and 68% were free of MACE. Univariate Cox analysis revealed that MACCE occurred more often in patients from the high-risk group based on the EuroSCORE II and those with longer lengths of the implanted stent(s) after the RA procedure. In multivariate Cox regression analysis, both high-risk category and mean stent(s) length were identified as independent predictors of MACCE. EuroSCORE II was confirmed to be the only independent predictor of MACE after RA.
Rotational atherectomy is a safe and sufficient technique for the endovascular treatment of heavily calcified coronary artery lesions. Individuals at a higher risk as assessed by the EuroSCORE II before RA and those with longer stent(s) implanted after RA are predisposed to MACCE in the follow-up.
旋磨术（RA）在当代经皮冠状动脉介入治疗（PCI）中发挥着重要作用，尤其是在人口老龄化和PCI适应证扩大的时代。
本研究旨在评估围手术期并发症发生率、RA的长期有效性，以及影响RA术后主要不良心脏事件（MACE）和主要心脑血管事件（MACCE）发生率的潜在因素。
本研究纳入了2002年1月至2016年5月期间连续60例行有效RA的患者。对患者进行了2616天的MACE和MACCE随访。
入选患者的平均年龄为72.1岁，男性占78.3%。平均随访期为835.3±611.8天。12例（20.0%）患者发生围手术期并发症。在长达2616天的随访中，64%的患者无MACCE，68%的患者无MACE。单因素Cox分析显示，根据欧洲心脏手术风险评估系统II（EuroSCORE II），高危组患者以及RA术后植入支架长度较长的患者发生MACCE的频率更高。在多因素Cox回归分析中，高危类别和平均支架长度均被确定为MACCE的独立预测因素。EuroSCORE II被证实是RA术后MACE的唯一独立预测因素。
旋磨术是治疗严重钙化冠状动脉病变的一种安全且有效的血管内治疗技术。RA术前经EuroSCORE II评估为高危的个体以及RA术后植入支架较长的个体在随访中易发生MACCE。
