2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Catheter Cardiovasc Interv. 2018 Oct 1;92(4):E278-E287. doi: 10.1002/ccd.27372. Epub 2017 Oct 25.
The aim of the study was to assess trends in the use and periprocedural outcomes of rotational atherectomy (RA) in Poland between January 2014 and December 2016.
In recent years, due to the aging population, RA is becoming more commonly used to treat heavily calcified coronary artery stenoses.
Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry on all percutaneous coronary intervention (PCI) procedures performed in Poland. In total, 1,175 RA procedures were recorded from 317,175 PCI procedures (incidence of 0.37%).
Patients undergoing RA were older (71.7 ± 9.7 vs. 66.9 ± 10.8, P < 0.00001) and less often males (68.3% vs. 76.4%, P < 0.00001). The complication rate was significantly higher in the RA group (P = 0.0012) with the leading coronary artery perforation (CAP) (P < 0.0001). Complication frequency decreased significantly in the last 3 years and was accompanied by an increase in the percentage of radial access and patients with stable angina. Among several predictors of the use of RA during PCI in multivariate analysis, the strongest one was previous coronary artery by-pass grafting (P < 0.0001), whereas the strongest, predictor of CAP was the RA procedure (P = 0.00004). The increase in RA frequency over the last 3 years may reflect population aging, some fluctuations in indications for RA and reimbursement policies.
We observed a substantial increase in the utilization of RA during PCIs performed in Poland; however, it still needs to be increased. Decreased frequency of RA procedures follows change in indications for RA and vascular access. Periprocedural complication rates significantly decreased over the last 3 years.
本研究旨在评估 2014 年 1 月至 2016 年 12 月期间波兰旋磨术（RA）的使用趋势及围术期结局。
近年来，由于人口老龄化，RA 越来越多地用于治疗重度钙化的冠状动脉狭窄。
使用波兰心血管介入学会全国注册系统前瞻性地收集了所有在波兰进行的经皮冠状动脉介入治疗（PCI）的相关数据。在总共 317175 例 PCI 中，记录到 1175 例 RA 术，发生率为 0.37%。
接受 RA 的患者年龄更大（71.7±9.7 岁比 66.9±10.8 岁，P<0.00001），男性比例更小（68.3%比 76.4%，P<0.00001）。RA 组的并发症发生率显著更高（P=0.0012），其中以冠状动脉穿孔（CAP）为主（P<0.0001）。在过去的 3 年中，并发症的发生频率显著下降，同时，RA 组的桡动脉入路和稳定性心绞痛患者比例也有所增加。在多变量分析中，RA 用于 PCI 的几个预测因素中，最强的是先前的冠状动脉旁路移植术（P<0.0001），而 CAP 的最强预测因素是 RA 术（P=0.00004）。过去 3 年来 RA 频率的增加可能反映了人口老龄化、RA 适应证的一些波动和报销政策的变化。
我们观察到波兰 PCI 中 RA 的应用显著增加，但仍需进一步增加。RA 术式的应用减少与 RA 适应证和血管入路的变化有关。过去 3 年来，围术期并发症发生率显著下降。
