Department of Cardiology, Tokyo Women's Medical University, Japan.
Department of Cardiology, Tokyo Women's Medical University, Japan.
Int J Cardiol. 2019 Jun 15;285:14-20. doi: 10.1016/j.ijcard.2019.03.022. Epub 2019 Mar 14.
Hemodialysis (HD) patients have heavy calcium deposits in their stenotic coronary arteries and worse post-percutaneous coronary intervention (PCI) prognoses than those who do not undergo HD. Rotational atherectomy (RA) facilitates PCI success in severely calcified lesions. We aimed to identify clinical and procedural characteristics that predict HD patients' long-term prognoses after PCI that included RA in the drug-eluting stent (DES) era.
This study included 302 patients who underwent regular HD from J2T Multicenter Registry database of 1090 consecutive patients who underwent RA to treat de novo calcified lesions at three university hospitals between 2004 and 2015. The primary endpoint was cardiovascular (CV) death.
During the 5-year observation period, 59 CV deaths (19.5%) occurred. The CV death group and non-CV death group had comparable profiles except significantly lower left ventricular ejection fraction, higher brain natriuretic peptide (BNP), lower rate of RA burr upsizing, and lower rate of final thrombolysis in myocardial infarction (TIMI) 3 flow achievement in the CV death group. Cox regression analysis revealed that increasing ablation burr size (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.13-0.81), final TIMI 3 flow (HR: 0.07; 95% CI: 0.02-0.28), lower BNP level, and optimal medication were independently associated with better CV mortality in HD patients.
In the DES era, oral medications at the time of PCI and stepwise calcium ablation were associated with improved long-term CV mortality in HD patients who are scheduled to undergo RA to treat severely calcified coronary artery stenoses, as therapeutic strategies.
血液透析（HD）患者的狭窄冠状动脉有大量钙沉积，与未接受 HD 的患者相比，经皮冠状动脉介入治疗（PCI）后的预后更差。旋磨术（RA）有利于药物洗脱支架（DES）时代严重钙化病变的 PCI 成功。我们旨在确定在包括 RA 的 PCI 后预测 HD 患者长期预后的临床和程序特征。
本研究纳入了 2004 年至 2015 年期间在三家大学医院接受 RA 治疗新出现的钙化病变的 1090 例连续患者的 J2T 多中心登记数据库中的 302 例接受常规 HD 的患者。主要终点是心血管（CV）死亡。
在 5 年观察期间，发生了 59 例 CV 死亡（19.5%）。CV 死亡组和非 CV 死亡组的特征相似，但 CV 死亡组的左心室射血分数明显较低，脑钠肽（BNP）较高，RA 磨头增大率较低，最终达到心肌梗死溶栓治疗（TIMI）3 级血流的比例较低。Cox 回归分析显示，增大消融磨头尺寸（风险比[HR]：0.33；95%置信区间[CI]：0.13-0.81）、最终 TIMI 3 级血流（HR：0.07；95% CI：0.02-0.28）、较低的 BNP 水平和最佳药物治疗与 HD 患者的 CV 死亡率降低独立相关。
在 DES 时代，PCI 时的口服药物和逐步钙消融与计划接受 RA 治疗严重钙化冠状动脉狭窄的 HD 患者的长期 CV 死亡率降低相关，可作为治疗策略。
