Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Sapporo Heart Center, Sapporo Cardio Vascular Clinic, Sapporo, Japan.
J Interv Cardiol. 2020 Jan 23;2020:9190702. doi: 10.1155/2020/9190702. eCollection 2020.
To introduce a modified rotational atherectomy (RA) procedure and investigate the early and midterm outcomes of the RA-facilitating diversified percutaneous coronary intervention (PCI) in a large group of aged patients with higher cardiovascular risk.
Previous studies about the outcomes of RA were limited with small sample size and low-risk population.
Between January 2013 and November 2015, 1169 consecutive patients treated with modified RA-facilitated PCI were retrospectively enrolled, including de novo calcified lesions and in-stent restenosis. Patients were regularly followed up for at least 1 year. Major adverse cardiac events (MACE) were analyzed for all participants by different strategies. Cox regression analysis was performed to identify risk factors for the events.
The median age of patients was 75 years, with 11.7% of patients on maintenance hemodialysis. Most lesions (99.9%) were complex (American Heart Association type B2/C), and 68.3% were treated with RA + drug-eluting-stent (DES). Successful angiography was achieved in 97.8% cases, with 1.7% (20/1169) experiencing coronary perforation (including guidewire perforation). The incidence of MACE was 20.5% and 26.8% at 1-year and 2-year follow-up and were mainly driven by target lesion revascularization (TLR) (10.3% and 12.5%, respectively). The strategy of RA + DES had the lowest 2-year MACE, compared with the RA + drug-coated balloon and RA + plain old balloon angioplasty (14.5%, 30.5%, and 26.0%, respectively).
The modified RA technique is a safe and effective tool in the contemporary PCI era, even in high-risk patients. The TLR rate was relatively high but acceptable in such complex lesions.
介绍一种改良的旋磨术（RA）程序，并研究在一组高心血管风险的老年患者中，RA 辅助多元化经皮冠状动脉介入治疗（PCI）的早期和中期结果。
以前关于 RA 结果的研究样本量小且人群风险低。
2013 年 1 月至 2015 年 11 月，回顾性纳入 1169 例接受改良 RA 辅助 PCI 治疗的连续患者，包括新发钙化病变和支架内再狭窄。所有患者定期随访至少 1 年。采用不同策略分析所有患者的主要不良心脏事件（MACE）。采用 Cox 回归分析确定事件的危险因素。
患者的中位年龄为 75 岁，11.7%的患者接受维持性血液透析。大多数病变（99.9%）为复杂病变（美国心脏协会 B2/C 型），68.3%的病变采用 RA+药物洗脱支架（DES）治疗。97.8%的病例成功进行了血管造影，1.7%（20/1169）发生冠状动脉穿孔（包括导丝穿孔）。1 年和 2 年随访时，MACE 的发生率分别为 20.5%和 26.8%，主要由靶病变血运重建（TLR）引起（分别为 10.3%和 12.5%）。与 RA+药物涂层球囊和 RA+普通球囊血管成形术相比，RA+DES 的 2 年 MACE 发生率最低（分别为 14.5%、30.5%和 26.0%）。
在当代 PCI 时代，改良 RA 技术是一种安全有效的工具，即使在高危患者中也是如此。在如此复杂的病变中，TLR 发生率较高，但可接受。
