Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA.
EuroIntervention. 2019 Apr 20;14(17):1760-1767. doi: 10.4244/EIJ-D-17-01060.
We sought to evaluate procedural complications and one-year clinical outcomes for patients who underwent percutaneous coronary intervention (PCI) with orbital (OA) and rotational atherectomy (RA).
From a total of 13,467 patients who underwent PCI in our hospital between January 2013 and June 2016, 1,149 consecutive patients were treated with atherectomy for moderately-severely calcified lesions (184 with OA, 965 with RA). Procedural complications were similarly observed in the two groups except for higher dissection and perforation rates with OA. Major adverse cardiovascular events (MACE) were defined as the composite of death, myocardial infarction or target lesion revascularisation. Multivariable adjusted analysis showed that OA use was associated with comparable adjusted one-year MACE compared to RA use (hazard ratio 0.79 [95% confidence interval 0.54-1.17], p=0.25). There were no significant differences in individual MACE endpoints. Furthermore, we studied 67 patients with OCT images. OCT analysis showed comparable tissue modification with a trend towards higher stent expansion with OA vs. RA.
OA use was associated with lower unadjusted but similar adjusted one-year MACE outcomes compared to RA with higher rates of dissection and device-induced perforation.
我们旨在评估经皮冠状动脉介入治疗（PCI）中使用轨道（OA）和旋转削切术（RA）的患者的手术并发症和一年临床结果。
在 2013 年 1 月至 2016 年 6 月期间，我们医院共有 13467 名患者接受了 PCI，其中 1149 名患者因中重度钙化病变接受了削切术治疗（184 名患者使用 OA，965 名患者使用 RA）。两组患者的手术并发症相似，但 OA 组的夹层和穿孔发生率更高。主要不良心血管事件（MACE）定义为死亡、心肌梗死或靶病变血运重建的复合终点。多变量调整分析显示，与 RA 相比，OA 的使用与调整后一年的 MACE 发生率相当（风险比 0.79 [95%置信区间 0.54-1.17]，p=0.25）。各个 MACE 终点无显著差异。此外，我们研究了 67 名接受 OCT 图像的患者。OCT 分析显示，OA 与 RA 相比，组织修饰相似，但支架扩张程度有升高趋势。
与 RA 相比，OA 的使用与较低的未调整但调整后的一年 MACE 结局相关，但夹层和器械诱导穿孔的发生率更高。
