Kyoto Katsura Hospital, Japan. Email:
Kyoto Katsura Hospital, Japan.
J Invasive Cardiol. 2023 Aug;35(8). doi: 10.25270/jic/23.00131.
Severely calcified lesions present many challenges for percutaneous coronary intervention (PCI). This study aimed to assess the safety and efficacy of the orbital atherectomy system (OAS) in treating calcified coronary lesions.
The present study included 422 consecutive cases (546 lesions) who underwent PCI with OAS in Kyoto Katsura Hospital from February 2018 to December 2021. We assessed the following clinical outcomes after OAS was used for severely calcified lesions: procedure success, angiographic complications, in-hospital Major Adverse Cardiovascular Events (MACE), and mid-term results. The primary endpoint was the combination of incidence of MACE at 12 months, cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR).
Of all the cases, 74% patients were men and the mean age was 76.5 years. In total, 81% of lesions were treated with drug-coated balloon, and 14% were implanted with stents. Procedural success rate was 96.3%. Coronary perforation occurred in 0.5% and persistent slow flow in 2% lesions. There was 1 cardiac death (0.5%), 43 periprocedural MIs (10.2%), and no TLR as in-hospital MACE. The incidence of MACE at 12 months was 8.4%, including 2.1% cardiac death and 6.9% TLR. In multivariate analysis, CKD, hemodialysis, and restenosis lesions were independently associated with MACE at 12 months. Periprocedural MI was not an independent predictor of MACE.
This study suggested that OAS is a safe and effective treatment option for calcified coronary lesions with acceptable acute and mid-term results; thus, it can be an alternate for reducing calcified plaque.
严重钙化病变给经皮冠状动脉介入治疗（PCI）带来了诸多挑战。本研究旨在评估轨道旋磨术系统（OAS）治疗钙化冠状动脉病变的安全性和疗效。
本研究纳入了 2018 年 2 月至 2021 年 12 月期间在京都桂医院接受 OAS 治疗的 422 例（546 处病变）连续病例。我们评估了 OAS 治疗严重钙化病变后的以下临床结局：手术成功率、血管造影并发症、院内主要不良心血管事件（MACE）和中期结果。主要终点是 12 个月时 MACE 发生率、心脏死亡、心肌梗死（MI）和靶病变血运重建（TLR）的联合发生率。
所有病例中，74%的患者为男性，平均年龄为 76.5 岁。81%的病变采用药物涂层球囊治疗，14%的病变植入支架。手术成功率为 96.3%。0.5%的病变出现冠状动脉穿孔，2%的病变出现持续慢血流。院内发生 1 例心脏死亡（0.5%）、43 例围手术期 MI（10.2%），无 TLR 发生。12 个月时 MACE 的发生率为 8.4%，包括 2.1%的心脏死亡和 6.9%的 TLR。多变量分析显示，CKD、血液透析和再狭窄病变是 12 个月时 MACE 的独立相关因素。围手术期 MI 不是 MACE 的独立预测因素。
本研究表明，OAS 是一种安全有效的治疗钙化冠状动脉病变的方法，具有可接受的急性和中期结果；因此，它可以作为减少钙化斑块的替代方法。
