Cuenza Lucky R, Jayme Ada Cherryl, Khe Sui James Ho
National Heart Center, Singapore, Philippines.
Philippine Heart Center, Metro Manila, Philippines.
Heart Views. 2017 Oct-Dec;18(4):115-120. doi: 10.4103/1995-705X.221231.
Rotational atherectomy (RA) is used to improve procedural success of percutaneous catheter interventions (PCIs) of complex and heavily calcified coronary lesions. We report the clinical experience and outcomes in our institution with the use of RA, followed by drug-eluting stent implantation.
Data of 81 patients treated with PCI and adjunctive RA were analyzed. Clinical follow-up for the occurrence of major adverse events (MAEs) was obtained in all patients and correlated with significant variables using multivariate Cox proportional hazards analysis.
Mean age was 67.9 ± 9.2 years, 61.7% had diabetes, 20.9% had chronic kidney disease, and 48.1% had previous acute coronary syndrome (ACS). Mean SYNTAX score was 29.8 ± 12.2, with a 92.5% angiographic success rate achieved. In-hospital MAEs rate was 7.4% while mortality rate was 8.6%. On median follow-up of 12.2 months, incidence of MAEs of 13.5% with a 75% free incidence from MAEs at 34 months. Multivariate analysis revealed that a history of previous ACS, ejection fraction, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, SYNTAX score, burr to artery ratio, and attainment of angiographic success were significant predictors of MAEs.
RA followed by drug-eluting stent implantation is a safe and effective method in improving procedural success as well as short- and long-term outcomes of PCI in our center. A combination of clinical and procedural factors is predictive for the occurrence of MAEs and should be taken into account in the application of this technique.
旋磨术（RA）用于提高复杂和严重钙化冠状动脉病变经皮导管介入治疗（PCI）的手术成功率。我们报告了我院使用RA并随后植入药物洗脱支架的临床经验和结果。
分析了81例行PCI及辅助RA治疗患者的数据。对所有患者进行主要不良事件（MAE）发生情况的临床随访，并使用多变量Cox比例风险分析将其与显著变量相关联。
平均年龄为67.9±9.2岁，61.7%患有糖尿病，20.9%患有慢性肾病，48.1%有既往急性冠状动脉综合征（ACS）病史。平均SYNTAX评分为29.8±12.2，血管造影成功率达到92.5%。住院期间MAE发生率为7.4%，死亡率为8.6%。中位随访12.2个月时，MAE发生率为13.5%，34个月时无MAE的发生率为75%。多变量分析显示，既往ACS病史、射血分数、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、SYNTAX评分、磨头与动脉比值以及血管造影成功与否是MAE的显著预测因素。
在我们中心，RA后植入药物洗脱支架是提高PCI手术成功率以及短期和长期结果的一种安全有效的方法。临床和手术因素的组合可预测MAE的发生，在应用该技术时应予以考虑。
