Tomasiewicz Brunon, Kubler Piotr, Zimoch Wojciech, Kosowski Michał, Wańha Wojciech, Ładziński Szymon, Rakotoarison Oscar, Ochała Andrzej, Wojakowski Wojciech, Reczuch Krzysztof
Department of Heart Diseases, Wroclaw Medical University.
Centre for Heart Diseases, University Hospital.
Circ J. 2021 May 25;85(6):867-876. doi: 10.1253/circj.CJ-20-1222. Epub 2021 Apr 22.
The aim of the study was to assess anatomical and procedural predictors of clinical and procedural failure of rotational atherectomy (RA) in an all-comers population.
A total of 534 consecutive patients who underwent RA were included in a double-center observational study. The primary composite endpoint consisted of: rota-wire introduction failure, burr-passage failure, periprocedural complications and procedure-related major adverse events. The second primary endpoint included rota-wire introduction failure and burr-passage failure. The primary endpoint occurred in 76 (14.2%) patients and the second primary endpoint occurred in 64 (12%) Periprocedural complications occurred in 23 (4.3%) and procedure-related adverse events in 23 (4.3%) patients. Multivariable analysis revealed angulation on lesion ≤90° (HR=2.18, 95% CI: 1.21-3.94, P=0.0096) and sequential lesion (HR=1.89, 95% CI: 1.01-3.54, P=0.046) as independent predictors of no clinical success of RA. Multivariable analysis revealed again that angulation on lesion ≤90° (HR=2.26, 95% CI: 1.16-4.40, P=0.02) and sequential lesion (HR=3.77, 95% CI: 1.64-8.69, P<0.01) as independent predictors of no procedural success of RA.
The presence of an acute angulation on lesion and sequential lesion are independent determinants of clinical and procedural failure of RA. Further research is necessary to establish a score predicting RA failure, which can help in preproceduralrisk stratification of patients undergoing complex percutaneous coronary intervention with RA.
本研究旨在评估在所有患者群体中，旋磨术（RA）临床及操作失败的解剖学和操作预测因素。
一项双中心观察性研究纳入了连续534例行RA的患者。主要复合终点包括：旋磨导丝置入失败、磨头通过失败、围手术期并发症及与手术相关的主要不良事件。第二个主要终点包括旋磨导丝置入失败和磨头通过失败。76例（14.2%）患者出现主要终点，64例（12%）患者出现第二个主要终点。23例（4.3%）患者出现围手术期并发症，23例（4.3%）患者出现与手术相关的不良事件。多变量分析显示，病变处成角≤90°（HR=2.18，95%CI：1.21 - 3.94，P=0.0096）和串联病变（HR=1.89，95%CI：1.01 - 3.54，P=0.046）是RA临床未成功的独立预测因素。多变量分析再次显示，病变处成角≤90°（HR=2.26，95%CI：1.16 - 4.40，P=0.02）和串联病变（HR=3.77，95%CI：1.64 - 8.69，P<0.01）是RA操作未成功的独立预测因素。结论：病变处急性成角和串联病变的存在是RA临床及操作失败的独立决定因素。有必要进一步研究建立一个预测RA失败的评分系统，这有助于对接受复杂经皮冠状动脉介入旋磨术患者进行术前风险分层。
