Wroclaw Medical University, Department of Heart Diseases, Weigla 5, 50-981 Wroclaw, Poland; Military Hospital, Weigla 5, 50-981 Wroclaw, Poland.
Kardiol Pol. 2018;76(9):1360-1368. doi: 10.5603/KP.a2018.0144. Epub 2018 Jul 5.
Rotational atherectomy (RA) is indicated for fibrocalcified lesions when traditional percutaneous coronary intervention (PCI) could not be successfully performed. In some of the high-risk patients the RA procedure is the last resort for successful revascularisation. Such patients are, among others, those in whom coronary artery bypass grafting (CABG) is not feasible.
The aim of the study was to assess in-hospital and one-year outcomes of PCI with RA in high-risk patients without other revascularisation options (RA-only group), in comparison to lower-risk patients undergoing RA.
We evaluated data of 207 consecutive patients who underwent PCI with RA. Primary endpoints were one-year all-cause mortality and one-year major adverse cardiac events (MACEs). Secondary endpoints were in-hospital outcomes.
During the study 35% of patients fulfilled the inclusion criteria to the high-risk group. Those patients had significantly lower left ventricular ejection fraction, more often prior CABG, higher admission glucose level, and higher EuroSCORE II and Syntax Score. Procedural success was similar in both groups (85% in RA-only group vs. 91% in remaining patients, p = 0.18). In-hospital outcomes were similar, except more frequent no/slow-flow phenomenon in the RA-only group. The MACE and mortality rates in one-year follow-up were not statistically different in both groups (19% vs. 18%, p = 0.82 and 11% vs. 9%, p = 0.64, respectively).
Despite the high-risk characteristics of the study subgroup, no significant differences between in-hospital and one-year outcomes were found in comparison to lower-risk RA patients. Complex PCI with RA in patients without other revascularisation options should be taken into consideration.
当传统经皮冠状动脉介入治疗（PCI）无法成功进行时，旋转血管成形术（RA）适用于纤维钙化病变。在某些高危患者中，RA 手术是成功血运重建的最后手段。这些患者包括不能进行冠状动脉旁路移植术（CABG）的患者等。
本研究旨在评估在没有其他血运重建选择（仅 RA 组）的高危患者中，与接受 RA 的低危患者相比，RA 联合 PCI 的住院和一年结果。
我们评估了 207 例连续接受 RA 联合 PCI 的患者的数据。主要终点是一年全因死亡率和一年主要不良心脏事件（MACEs）。次要终点是住院期间的结果。
在研究期间，35%的患者符合高危组的纳入标准。这些患者的左心室射血分数明显较低，更频繁地接受过 CABG，入院时血糖水平更高，EuroSCORE II 和 Syntax 评分更高。两组的手术成功率相似（仅 RA 组为 85%，其余患者为 91%，p = 0.18）。两组的住院期间结果相似，但仅 RA 组更常出现无/慢血流现象。在一年的随访中，两组的 MACE 和死亡率无统计学差异（19%对 18%，p = 0.82 和 11%对 9%，p = 0.64）。
尽管研究亚组具有高危特征，但与低危 RA 患者相比，在住院和一年的结果方面没有发现显著差异。在没有其他血运重建选择的患者中，应考虑进行复杂的 RA 联合 PCI。
