Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
PLoS One. 2021 Apr 26;16(4):e0250757. doi: 10.1371/journal.pone.0250757. eCollection 2021.
Although several groups reported the risk factors for slow flow during rotational atherectomy (RA), they did not clearly distinguish modifiable factors, such as burr-to-artery ratio from unmodifiable ones, such as lesion length. The aim of this retrospective study was to investigate the modifiable and unmodifiable factors that were associated with slow flow.
We included 513 lesions treated with RA, which were classified into a slow flow group (n = 97) and a non-slow flow group (n = 416) according to the presence or absence of slow flow just after RA. The multivariate logistic regression analysis was performed to find factors associated with slow flow.
Slow flow was inversely associated with reference diameter [Odds ratio (OR) 0.351, 95% confidence interval (CI) 0.205-0.600, p<0.001], primary RA strategy (OR 0.224, 95% CI 0.097-0.513, p<0.001), short single run (≤15 seconds) (OR 0.458, 95% CI 0.271-0.776, p = 0.004), and systolic blood pressure (BP) ≥ 140 mmHg (OR 0.501, 95% CI 0.297-0.843, p = 0.009). Lesion length (every 5 mm increase: OR 1.193, 95% CI 1.093-1.301, p<0.001), angulation (OR 2.054, 95% CI 1.171-3.601, p = 0.012), halfway RA (OR 2.027, 95% CI 1.130-3.635, p = 0.018), initial burr-to-artery ratio (OR 1.451, 95% CI 1.212-1.737, p<0.001), and use of beta blockers (OR 1.894, 95% CI 1.004-3.573, p = 0.049) were significantly associated with slow flow.
Slow flow was positively associated with several unmodifiable factors including lesion length and angulation, and inversely associated with reference diameter. In addition, slow flow was positively associated with several modifiable factors including initial burr-to-artery ratio and use of beta blockers, and inversely associated with primary RA strategy, short single run, and systolic blood pressure just before RA. Application of this information could help to improve RA procedures.
尽管有几个小组报告了旋磨术（RA）过程中血流缓慢的风险因素，但他们并没有明确区分可改变的因素，例如磨头-血管比与不可改变的因素，例如病变长度。本回顾性研究的目的是探讨与血流缓慢相关的可改变和不可改变的因素。
我们纳入了 513 例接受 RA 治疗的病变，根据 RA 后是否存在血流缓慢，将其分为血流缓慢组（n=97）和非血流缓慢组（n=416）。采用多变量逻辑回归分析寻找与血流缓慢相关的因素。
血流缓慢与参考直径呈负相关（比值比 0.351，95%置信区间 0.205-0.600，p<0.001），与初次 RA 策略（比值比 0.224，95%置信区间 0.097-0.513，p<0.001）、单次短运行（≤15 秒）（比值比 0.458，95%置信区间 0.271-0.776，p=0.004）和收缩压（BP）≥140mmHg（比值比 0.501，95%置信区间 0.297-0.843，p=0.009）呈负相关。病变长度（每增加 5mm：比值比 1.193，95%置信区间 1.093-1.301，p<0.001）、角度（比值比 2.054，95%置信区间 1.171-3.601，p=0.012）、RA 中途（比值比 2.027，95%置信区间 1.130-3.635，p=0.018）、初始磨头-血管比（比值比 1.451，95%置信区间 1.212-1.737，p<0.001）和β受体阻滞剂的使用（比值比 1.894，95%置信区间 1.004-3.573，p=0.049）与血流缓慢显著相关。
血流缓慢与多个不可改变的因素（包括病变长度和角度）呈正相关，与参考直径呈负相关。此外，血流缓慢与多个可改变的因素（包括初始磨头-血管比和β受体阻滞剂的使用）呈正相关，与初次 RA 策略、单次短运行和 RA 前收缩压呈负相关。应用这些信息可以帮助改善 RA 手术。
