MacIsaac A I, Bass T A, Buchbinder M, Cowley M J, Leon M B, Warth D C, Whitlow P L
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44106, USA.
J Am Coll Cardiol. 1995 Sep;26(3):731-6. doi: 10.1016/0735-1097(95)00206-J.
This study sought to determine the success and complication rates of high speed rotational coronary atherectomy in calcified and noncalcified lesions.
Percutaneous transluminal coronary angioplasty and directional coronary atherectomy of calcified lesions are associated with reduced procedural success and increased complications. Rotational atherectomy using the Rotablator catheter abrades noncompliant plaque and may improve outcome in calcified lesions.
Data from the completed Multicenter Rotablator Registry of 2,161 rotational atherectomy procedures in single lesions were analyzed to determine the relative efficacy of rotational atherectomy for 1,078 calcified and 1,083 noncalcified lesions. The power of the study was 0.86 to detect a significant difference in outcome, if the true success rates in the noncalcified and calcified lesions were 96% and 93%, respectively.
Patients with calcified lesions were older (mean [+/- SD] age 66.2 +/- 10.3 vs. 60.5 +/- 11.0 years, p = 0.0001) than those with noncalcified lesions. Calcified lesions were more frequently new (75% vs. 64%, p = 0.0001), angulated (27% vs. 22%, p = 0.02), eccentric (75% vs. 64%, p = 0.0001) and long (32% vs. 27%, > 10 mm in length, p = 0.01). They were also more often complex (57% vs. 46%, p = 0.001) and located in the left anterior descending coronary artery (51% vs. 44%, p = 0.001). Adjunctive coronary angioplasty was used in 82.9% of calcified and 66.9% of noncalcified lesions. Procedural success, defined as < 50% residual stenosis without major complications, was achieved in 94.3% of calcified and 95.2% of noncalcified lesions (p = 0.32). Major complication rates were 4.1% in calcified and 3.1% in noncalcified lesions (p = 0.24). Non-Q wave myocardial infarction was documented in 10.0% of calcified and 7.7% of noncalcified lesions (p = 0.054). Mean postprocedural residual stenosis was 21.6 +/- 13.9% in calcified and 23.3 +/- 15% in noncalcified lesions (p = 0.39).
In this review of data from a large multicenter registry, the success rate of rotational atherectomy was not reduced by calcification despite the more frequent complex nature of the calcified lesions. The Rotablator catheter is likely to be the device of choice for percutaneous intervention in calcified lesions, but definitive conclusions await the results of randomized trials.
本研究旨在确定高速旋磨冠状动脉成形术治疗钙化和非钙化病变的成功率及并发症发生率。
经皮腔内冠状动脉成形术及钙化病变的定向冠状动脉斑块旋切术与手术成功率降低及并发症增加相关。使用旋磨导管进行旋磨术可磨除顺应性差的斑块，并可能改善钙化病变的治疗效果。
分析来自已完成的多中心旋磨登记研究的2161例单病变旋磨术的数据，以确定旋磨术对1078例钙化病变和1083例非钙化病变的相对疗效。若非钙化和钙化病变的真实成功率分别为96%和93%，则本研究的检验效能为0.86，以检测结果的显著差异。
钙化病变患者比非钙化病变患者年龄更大（平均[±标准差]年龄66.2±10.3岁对60.5±11.0岁，p = 0.0001）。钙化病变更常见为新发病变（75%对64%，p = 0.0001）、成角病变（27%对22%，p = 0.02）、偏心病变（75%对64%，p = 0.0001）和长病变（32%对27%，长度>10mm，p = 0.01）。它们也更常为复杂病变（5
