Kübler Piotr, Zimoch Wojciech, Kosowski Michał, Tomasiewicz Brunon, Telichowski Artur, Reczuch Krzysztof
Department of Heart Diseases, Medical University, Wroclaw, Poland; Military Hospital, Wroclaw, Poland.
Department of Heart Diseases, Medical University, Wroclaw, Poland; Military Hospital, Wroclaw, Poland.
J Cardiol. 2018 Apr;71(4):382-388. doi: 10.1016/j.jjcc.2017.10.012. Epub 2017 Nov 22.
Rotational atherectomy (RA) is an acknowledged method of percutaneous treatment of highly calcified or fibrotic coronary lesions. However, using the rotablator system in patients presenting with acute coronary syndromes (ACS) remains controversial and is considered as a relative contraindication. The aim of our study was to assess in-hospital and 1-year outcomes in patients undergoing RA presenting with ACS, in comparison to elective RA procedures.
This single-center observational study included all consecutive patients who underwent RA and PCI in our institution from April 2008 to October 2015. All patients were subsequently divided into two groups based on clinical presentation: stable angina group (SA) and ACS group. Primary endpoints were in-hospital and 1-year all-cause mortality and 1-year major adverse cardiac events (MACE). Secondary endpoints were procedural success and in-hospital complications.
The study included 207 patients, 164 (79%) in SA group and 43 (21%) in ACS group. In-hospital mortality was higher in patients with ACS (4.7% vs. 0%, p=0.01). Procedural success was similar in both groups, 93% in ACS groups vs. 92.7% in SA group, p=0.94. There were no significant differences in the rate of periprocedural complications (4.7% vs. 10.4%, p=0.25), however postprocedural complications were more frequent in ACS group. At 1-year follow-up MACE rate and mortality were numerically higher, however statistically not significant (25.6% vs. 16.5%, p=0.17 and 16.3% vs. 7.9%, p=0.10; respectively).
Despite higher mortality and complication rate in ACS group observed in postprocedural period, we found no significant difference in 1-year outcomes in comparison to elective patients. Procedural success of RA in ACS patients is similar to elective patients with SA and this procedure should be considered in case of urgent indications, if no other options of treatment exist.
旋磨术（RA）是经皮治疗高度钙化或纤维化冠状动脉病变的一种公认方法。然而，在急性冠状动脉综合征（ACS）患者中使用旋磨系统仍存在争议，被视为相对禁忌证。我们研究的目的是评估与择期RA手术相比，接受RA治疗的ACS患者的院内及1年结局。
这项单中心观察性研究纳入了2008年4月至2015年10月在我们机构接受RA和PCI的所有连续患者。所有患者随后根据临床表现分为两组：稳定型心绞痛组（SA）和ACS组。主要终点是院内及1年全因死亡率和1年主要不良心脏事件（MACE）。次要终点是手术成功率和院内并发症。
该研究纳入207例患者，SA组164例（79%），ACS组43例（21%）。ACS患者的院内死亡率更高（4.7%对0%，p=0.01）。两组的手术成功率相似，ACS组为93%，SA组为92.7%，p=0.94。围手术期并发症发生率无显著差异（4.7%对10.4%，p=0.25），但ACS组术后并发症更常见。在1年随访时，MACE发生率和死亡率在数值上更高，但无统计学意义（分别为25.6%对16.5%，p=0.17和16.3%对7.9%，p=0.10）。
尽管在术后观察到ACS组死亡率和并发症发生率较高，但我们发现与择期患者相比，1年结局无显著差异。RA在ACS患者中的手术成功率与SA择期患者相似，在没有其他治疗选择且有紧急指征的情况下应考虑采用该手术。
Zotero 插件