Wu Jiawei, Qiu Guangquan, Hu Hao, Ma Li-Kun
Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, 230001 Hefei, Anhui, China.
Department of Cardiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, 230001 Hefei, Anhui, China.
Rev Cardiovasc Med. 2023 Jan 6;24(1):13. doi: 10.31083/j.rcm2401013. eCollection 2023 Jan.
Rotational atherectomy (RA) is an important technique for the management of severe coronary calcification. However, optimal rotational speed is yet to be defined.
A total of 372 coronary heart disease (CHD) patients were retrospectively analyzed between February 2017 and January 2022. The patients were divided into four groups based on the maximum RA speed: group 1 ( 150,000 rpm, 76 cases), group 2 (150,000 rpm, 156 cases), group 3 (160,000 rpm, 90 cases) and group 4 ( 170,000 rpm, 50 cases). The outcomes analyzed were procedural complications, six-months major cardiovascular and cerebrovascular events (MACCE) and chronic heart failure.
Patients in group 4 had a higher incidence of slow flow during the RA operation ( = 0.025). There was no significant difference in other complications among the four groups, as well as six-month MACCE. After adjusting for confounding factors, increase in rotational speed led to a higher probability of slow flow ( for non-linearity = 0.131; adjusted model) and MACCE ( for non-linearity = 0.183; adjusted model). Logistic regression analysis showed that rotational speed was a predictor of slow flow during RA operation (OR = 1.25, 95% CI: 1.051.49, = 0.01). Moreover, the analysis demonstrated that individuals with lower rotational speed ( 150,000 rpm) were at 230% higher risk of vasospasm compared with a higher rotational speed (160,000 rpm) (OR = 3.3, 95% CI: 1.0810.09, = 0.036).
CHD patients treated with a rotational speed of 170,000 rpm had a higher risk of slow flow after RA. Rotational speed is an independent risk factor for slow flow in CHD patients. Moreover, a rotational speed of 150,000 rpm was associated with a higher risk of vasospasm compared with rotational speed of 160,000 rpm. There was no significant difference in six-month outcomes in comparison to elective CHD patients with different rotational speeds, and the probability of MACCE was intensified with increase in rotational speed.
旋磨术（RA）是治疗严重冠状动脉钙化的一项重要技术。然而，最佳转速尚未确定。
回顾性分析2017年2月至2022年1月期间共372例冠心病（CHD）患者。根据最大旋磨速度将患者分为四组：第1组（<150,000转/分钟，76例）、第2组（150,000转/分钟，156例）、第3组（160,000转/分钟，90例）和第4组（>170,000转/分钟，50例）。分析的结果包括手术并发症、六个月主要心脑血管事件（MACCE）和慢性心力衰竭。
第4组患者在旋磨手术期间慢血流发生率较高（P = 0.025）。四组之间的其他并发症以及六个月MACCE方面无显著差异。在调整混杂因素后，转速增加导致慢血流（非线性P = 0.131；调整模型）和MACCE（非线性P = 0.183；调整模型）的可能性更高。逻辑回归分析表明，转速是旋磨手术期间慢血流的一个预测因素（OR = 1.25，95%CI：1.051.49，P = 0.01）。此外，分析表明，与较高转速（160,000转/分钟）相比，转速较低（<150,000转/分钟）的个体发生血管痉挛的风险高230%（OR = 3.3，95%CI：1.0810.09，P = 0.036）。
接受>170,000转/分钟转速治疗的冠心病患者在旋磨术后慢血流风险较高。转速是冠心病患者慢血流的一个独立危险因素。此外，与160,000转/分钟的转速相比，150,000转/分钟的转速与更高的血管痉挛风险相关。与不同转速的择期冠心病患者相比，六个月结局无显著差异，且MACCE的可能性随转速增加而增加。
