Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany.
Cardiology Department, Zagazig University, Sharkia, Egypt.
J Interv Cardiol. 2022 Dec 27;2022:2593189. doi: 10.1155/2022/2593189. eCollection 2022.
The role of rotational atherectomy (RA) in contemporary percutaneous coronary intervention (PCI) is expanding to include certain chronic total occlusion (CTO) lesions. However, the long-term outcome of RA in CTOs is still unclear.
To investigate in-hospital and long-term outcomes after RA for CTO compared to non-CTO calcified lesions. Moreover, this report evaluates the role of the elective RA approach in calcified CTOs.
This study enrolled 812 patients (869 lesions; CTO, = 80 versus non-CTO, = 789). The mean age of the study population was 73.1 ± 8.6 years, the baseline characteristics were comparable in both groups. Balloon-resistant CTO lesions represented the main indication for RA in CTO patients (61.2%). The mean J-CTO score was 2.42 ± 0.95. The angiographic success rate was lower in CTO patients (88.8% vs 94.9%; = 0.022). In-hospital major adverse cardiac events (MACE) rate was comparable in both groups (CTO 8.8% vs 7.0% in non-CTO; = 0.557). At two-year follow-up, a higher target lesion failure (TLF) was observed in CTO group (25.5% vs 15.1%, log rank = 0.041), driven by higher cardiac mortality while the clinically driven target lesion revascularisation (TLR) was comparable between the study groups. Elective RA for CTO had a shorter procedural time and lower rate of dissection (7.5% vs 25%; = 0.030) compared to bail-out RA with similar long-term outcomes.
Compared to non-CTO, RA for CTO can be performed with a high procedural success rate and comparable in-hospital outcomes. Apart from higher cardiac mortality in the CTO group, the long-term outcomes are comparable in both groups. Elective RA is a feasible and beneficial approach to be used in CTO intervention.
在当代经皮冠状动脉介入治疗（PCI）中，旋磨术（RA）的作用不断扩大，包括某些慢性完全闭塞（CTO）病变。然而，RA 治疗 CTO 的长期结果仍不清楚。
比较 RA 治疗 CTO 与非 CTO 钙化病变的住院和长期结果。此外，本报告评估了选择性 RA 方法在钙化 CTO 中的作用。
本研究纳入了 812 名患者（869 处病变；CTO = 80 例，非 CTO = 789 例）。研究人群的平均年龄为 73.1 ± 8.6 岁，两组的基线特征相当。球囊抵抗性 CTO 病变是 CTO 患者 RA 的主要适应证（61.2%）。平均 J-CTO 评分 2.42 ± 0.95。CTO 患者的血管造影成功率较低（88.8% vs 94.9%； = 0.022）。两组住院期间主要不良心脏事件（MACE）发生率相当（CTO 8.8% vs 非 CTO 7.0%； = 0.557）。两年随访时，CTO 组的靶病变失败（TLF）较高（25.5% vs 15.1%，log rank = 0.041），主要是由于心脏死亡率较高，而两组的临床驱动的靶病变血运重建（TLR）相当。与紧急 RA 相比，CTO 的选择性 RA 具有较短的手术时间和较低的夹层发生率（7.5% vs 25%； = 0.030），但长期结果相似。
与非 CTO 相比，RA 治疗 CTO 可获得较高的手术成功率，且住院期间的结果相当。除了 CTO 组的心脏死亡率较高外，两组的长期结果相当。选择性 RA 是 CTO 介入治疗中一种可行且有益的方法。
