Li Hui, Peng Xi, Li Le, Feng Yun-Di, Tang Guo-Dong, Zhao Ying, Yang Guo-Jian, Zheng Nai-Xin, Sun Fu-Cheng, Ai Hu, Zhang Hui-Ping
Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730 Beijing, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100037 Beijing, China.
Rev Cardiovasc Med. 2022 Sep 28;23(10):330. doi: 10.31083/j.rcm2310330. eCollection 2022 Oct.
There are scarce published data reporting the effect of rotational atherectomy (RA) on coronary microcirculation function.
We aimed to evaluate coronary microcirculation function indicated by the coronary angiography-derived index of microvascular resistance (caIMR) in patients undergoing RA.
RA procedures between January 2013 and December 2021 were retrospectively analyzed. We investigated coronary microcirculation function indicated by caIMR as well as peri-procedural adverse events among the study population. All caIMR measurements were performed using a FlashAngio system. The primary outcome was a composite of post-RA thrombolysis in myocardial infarction (TIMI) flow grade 3 in the target vessel, myocardial injury, procedure-related myocardial infarction, and cardiac death during hospitalization.
A total of 155 RA procedures were analyzed. The post-RA caIMRs were significantly higher than pre-RA caIMRs in the target vessels (16.0 7.0 vs. 14.5 7.5, = 0.029). Patients with post-RA caIMR 25 accounted for nearly 12% of those with pre-RA caIMR 25. Patients with post-RA thrombolysis in myocardial infarction (TIMI) flow grade 3 had a significantly higher pre-RA caIMR (23.5 10.2 vs. 13.7 6.6, = 0.005), and the proportion of patients with pre-RA caIMR 25 in the group with TIMI flow grade 3 was greater (61.5% vs. 38.5%, 0.001) than that in the group with TIMI flow grade of 3. Maximum RA time of each pass (odds ratio: 1.127, 95% confidence interval: 1.025-1.239, = 0.014) and pre-RA caIMR 25 (odds ratio: 3.254, 95% confidence interval: 1.054-10.048, = 0.040) were identified to be the independent predictors of the primary outcome for patients who underwent RA.
There were significant changes in the coronary microcirculation function of the target vessels after receiving RA as indicated by increased post-RA caIMR compared to pre-RA caIMR. Patients with baseline coronary microcirculatory dysfunction were more likely to have post-RA TIMI flow grade 3, whereas those with pre-RA caIMR 25 experienced worse outcomes.
关于旋磨术（RA）对冠状动脉微循环功能影响的已发表数据很少。
我们旨在评估接受RA治疗患者中由冠状动脉造影衍生的微血管阻力指数（caIMR）所指示的冠状动脉微循环功能。
对2013年1月至2021年12月期间的RA手术进行回顾性分析。我们调查了研究人群中由caIMR指示的冠状动脉微循环功能以及围手术期不良事件。所有caIMR测量均使用FlashAngio系统进行。主要结局是RA术后靶血管心肌梗死溶栓（TIMI）血流3级、心肌损伤、手术相关心肌梗死和住院期间心源性死亡的复合结局。
共分析了155例RA手术。靶血管中RA术后caIMR显著高于RA术前caIMR（16.0±7.0 vs. 14.5±7.5，P = 0.029）。RA术后caIMR≥25的患者占RA术前caIMR≥25患者的近12%。RA术后TIMI血流3级的患者术前caIMR显著更高（23.5±10.2 vs. 13.7±6.6，P = 0.005），且TIMI血流3级组中术前caIMR≥25的患者比例（61.5% vs. 38.5%，P<0.001）高于TIMI血流<3级组。每次旋磨的最长时间（比值比：1.127，95%置信区间：1.025 - 1.239，P = 0.014）和术前caIMR≥25（比值比：3.254，95%置信区间：1.054 - 10.048，P = 0.040）被确定为接受RA治疗患者主要结局的独立预测因素。
与RA术前相比，RA术后caIMR升高表明接受RA治疗后靶血管的冠状动脉微循环功能发生了显著变化。基线冠状动脉微循环功能障碍的患者更有可能出现RA术后TIMI血流3级，而术前caIMR≥25的患者结局更差。
