Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy -
Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy.
Minerva Cardioangiol. 2020 Apr;68(2):126-133. doi: 10.23736/S0026-4725.20.05096-3. Epub 2020 Feb 25.
Heavy calcified lesions can decrease effectiveness of drug eluted stents in preventing restenosis. Rotational atherectomy (RA) demonstrated to improve outcomes in patients with severely calcified lesions pretreated with debulking. However, its feasibility and its safety are continuously on stage. Our aim has been to identify predictors of clinical and procedural outcome in RA.
We retrospectively analyzed a population of patients referred to our cath lab for urgent or elective coronary catheterization treated with RA. The associations between clinical variables and clinical or procedural events were evaluated using logistic regression. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) from procedure date to last day of follow-up. MACE have been defined as follows: cardiovascular death, heart failure hospitalization and target lesion revascularization.
The registry included 68 of the 1908 (3.6%) patients that underwent percutaneous coronary intervention. Procedural success was as high as 94% and more than 90% of cases were treated without any complication. The most common complication during PCI with RA was vessel dissection (8.8%) and no procedural death occurred. None of the clinical nor procedural characteristics were associated with burr entrapment or vascular access hematoma. We identified as independent predictor of treated vessel dissection the female sex (OR 16.9, 95% CI 1.55-183.77, P<0.05). Logistic regression revealed age (OR 1.17, 95% CI: 1.02-1.33, P<0.02) as the only independent predictor of MACE. We therefore calculated the ROC curve on age in predicting MACE, that showed a C-statistics of 0.75 (95% CI 0.628 to 0.852, P=0.02), with 80 years old as the best threshold in defining high risk population.
RA is a feasible and safe procedure. Females and elderly patients must be carefully selected in order to balance the risk/benefit ratio in these high-risk populations.
重度钙化病变可降低药物洗脱支架预防再狭窄的效果。旋磨术（RA）已被证明可改善经预处理斑块消蚀术治疗的严重钙化病变患者的结局。然而，其可行性和安全性仍在不断发展。我们的目的是确定 RA 患者临床和程序结局的预测因素。
我们回顾性分析了因紧急或择期冠状动脉造影而转诊至我们导管室的患者人群，这些患者接受了 RA 治疗。使用逻辑回归评估临床变量与临床或程序事件之间的关联。主要终点是从程序日期到最后一次随访的主要不良心血管事件（MACE）的发生。MACE 定义如下：心血管死亡、心力衰竭住院和靶病变血运重建。
该注册研究包括 1908 例接受经皮冠状动脉介入治疗的患者中的 68 例（3.6%）。程序成功率高达 94%，超过 90%的病例无需任何并发症即可治疗。RA 下 PCI 最常见的并发症是血管夹层（8.8%），无手术死亡。没有任何临床或程序特征与磨头嵌顿或血管入路血肿有关。我们发现女性是治疗血管夹层的独立预测因素（OR 16.9，95%CI 1.55-183.77，P<0.05）。逻辑回归显示年龄（OR 1.17，95%CI：1.02-1.33，P<0.02）是 MACE 的唯一独立预测因素。因此，我们计算了年龄预测 MACE 的 ROC 曲线，显示 C 统计量为 0.75（95%CI 0.628 至 0.852，P=0.02），80 岁是定义高危人群的最佳阈值。
RA 是一种可行且安全的手术。女性和老年患者在这些高危人群中必须谨慎选择，以平衡风险/获益比。
