Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Cardiology, Hangzhou, Zhejiang, CN.
Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province.
Medicine (Baltimore). 2021 Mar 26;100(12):e25323. doi: 10.1097/MD.0000000000025323.
The optimal strategy for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation remains debatable. This study sought to compare the performance of rotational atherectomy (RA) and modified balloon (MB)-based strategy in patients with HCCL receiving current-generation DES.This retrospective study comprised 564 consecutive patients who underwent RA (n = 229) or MB (n = 335) for HCCL at our hospital and were treated with DES. Baseline clinical and angiographic data was obtained from our database. Patients were clinically monitored for the occurrence of any adverse events during the hospitalization. One-year follow-up was conducted by either telephone contact or outpatient visits. 1:1 propensity score matching (PSM) was performed to balance the baseline covariates. After PSM, the clinical outcomes between the 2 groups were compared.After PSM, except more target lesion in right coronary artery existing in the RA group (P = .008), no significant statistical differences were shown in regard of the other angiographic and procedural characteristics of the 2 groups. Strategy success rates were all 100% in both groups. In the unadjusted Cox proportional hazard analysis, participants with RA had a significantly lower risk of target lesion revascularization (TLR) (hazard ratio, HR 0.275, 95% confidence intervals, CI 0.119-0.635, P = .003) and major adverse cardiac event (MACE) (HR 0.488, 95% 0.277-0.859, P = .013). After adjusting for potential confounding variables, RA was significantly associated with TLR (HR 0.32, 95% 0.12-0.853, P = .023), but no longer significantly associated with MACE (HR 0.674, 95% 0.329-1.381, P = .282).In patients with HCCL, lesion preparation with RA was safe and could improve strategy success rate. There was lower rate of TLR with RA, however, no significant difference was found in the MACE rate at 1-year follow-up between RA and MB-based strategy.
在接受药物洗脱支架 (DES) 植入术前，对重度钙化冠状动脉病变 (HCCL) 进行病变准备的最佳策略仍存在争议。本研究旨在比较旋磨术 (RA) 和改良球囊 (MB) 策略在接受新一代 DES 治疗的 HCCL 患者中的表现。
这项回顾性研究纳入了在我院接受 RA（n=229）或 MB（n=335）治疗 HCCL 并接受 DES 治疗的 564 例连续患者。从我们的数据库中获得了基线临床和血管造影数据。在住院期间，对患者进行临床监测以观察任何不良事件的发生。通过电话联系或门诊随访进行为期 1 年的随访。采用 1:1 倾向评分匹配（PSM）来平衡基线协变量。PSM 后，比较两组患者的临床结局。
PSM 后，除 RA 组右冠状动脉靶病变更多（P=0.008）外，两组的其他血管造影和操作特征无显著统计学差异。两组的策略成功率均为 100%。在未调整的 Cox 比例风险分析中，RA 组患者靶病变血运重建（TLR）（风险比，HR 0.275，95%置信区间，CI 0.119-0.635，P=0.003）和主要不良心脏事件（MACE）（HR 0.488，95% CI 0.277-0.859，P=0.013）的风险显著降低。调整潜在混杂因素后，RA 与 TLR 显著相关（HR 0.32，95% CI 0.12-0.853，P=0.023），但与 MACE 无显著相关性（HR 0.674，95% CI 0.329-1.381，P=0.282）。
在 HCCL 患者中，RA 进行病变准备是安全的，可以提高策略成功率。RA 组 TLR 发生率较低，但 RA 组和 MB 组在 1 年随访时的 MACE 发生率无显著差异。
