James Cockburn1, David Hildick-Smith2, James Cotton3, Sagar Doshi4, Colm Hanratty5, Peter Ludman4, Derek Robinson6, Simon Redwood7, Mark de Belder8, Adam de Belder9. 1. Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. Electronic address: jacockburn@hotmail.com. 2. Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. 3. Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK. 4. Queen Elizabeth Hospital NHS Trust, Birmingham, UK. 5. Belfast NHS Trust, Belfast, UK. 6. Department of Mathematics, Sussex University, UK. 7. King's Health Partners, Rayne Institute, St Thomas' Campus, London, UK. 8. The James Cook University Hospital, Middlesbrough, UK. 9. Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. Electronic address: adam.debelder@bsuh.nhs.uk.
Abstract
INTRODUCTION: Rotational atherectomy (RA) is widely used for treating calcified coronary lesions. Clinical data however remain limited. METHODS: We assessed outcome and survival among patients undergoing percutaneous coronary intervention (PCI) with or without RA in the UK between September 2007 and March 2011. RESULTS: Data from 221,669 percutaneous coronary intervention (PCI) procedures were analysed; 2152 patients (0.97%) underwent RA (RA+); the remainder underwent conventional PCI (RA-). RA+ patients were older (71.7±9.6 vs. 64.1±12.8 year; p<0.001), and had a higher incidence of diabetes (26.4% vs. 18.0%; p<0.001), hypertension, (61.9% vs. 49.4%; p<0.001), peripheral vascular disease (9.9% vs. 4.2%, p<0.001), cerebrovascular disease (5.5% vs. 3.4%, p<0.001), renal impairment (3.4% vs. 1.5%, p<0.001) and poor left ventricular function (11.4% vs. 4.3%,p<0.001). Procedural success was lower among RA+ patients (90.3% vs 94.6%; p<0.001) and procedural complications were more frequent (9.7% vs 5.4%; p<0.001). After 2.4±1.2 years follow-up, unadjusted Cox proportional hazard modeling demonstrated poorer survival for RA+ patients (HR 2.21, 95%CI 1.97-2.49; p<0.0001). This disadvantage remained after adjustment for adverse variables (HR 1.26, 95%CI 1.11-1.44; p=0.0004) and following propensity analysis. There was evidence however of improved survival for RA+ patients with left main stem disease (HR 0.52, 95%CI 0.35-0.75, p<0.0001), and peripheral vascular disease (HR 0.65, 95%CI 0.43-0.98, p<0.0005). CONCLUSIONS: Rotational atherectomy was undertaken in patients with higher pre-procedural risk. Medium term survival was worse among patients undergoing rotational atherectomy, and this survival disadvantage remained after correction for available adverse factors. Rotational atherectomy however remains clinically useful for patients with calcified coronary lesions.
INTRODUCTION: Rotational atherectomy (RA) is widely used for treating calcified coronary lesions. Clinical data however remain limited. METHODS: We assessed outcome and survival among patients undergoing percutaneous coronary intervention (PCI) with or without RA in the UK between September 2007 and March 2011. RESULTS: Data from 221,669 percutaneous coronary intervention (PCI) procedures were analysed; 2152 patients (0.97%) underwent RA (RA+); the remainder underwent conventional PCI (RA-). RA+ patients were older (71.7±9.6 vs. 64.1±12.8 year; p<0.001), and had a higher incidence of diabetes (26.4% vs. 18.0%; p<0.001), hypertension, (61.9% vs. 49.4%; p<0.001), peripheral vascular disease (9.9% vs. 4.2%, p<0.001), cerebrovascular disease (5.5% vs. 3.4%, p<0.001), renal impairment (3.4% vs. 1.5%, p<0.001) and poor left ventricular function (11.4% vs. 4.3%,p<0.001). Procedural success was lower among RA+ patients (90.3% vs 94.6%; p<0.001) and procedural complications were more frequent (9.7% vs 5.4%; p<0.001). After 2.4±1.2 years follow-up, unadjusted Cox proportional hazard modeling demonstrated poorer survival for RA+ patients (HR 2.21, 95%CI 1.97-2.49; p<0.0001). This disadvantage remained after adjustment for adverse variables (HR 1.26, 95%CI 1.11-1.44; p=0.0004) and following propensity analysis. There was evidence however of improved survival for RA+ patients with left main stem disease (HR 0.52, 95%CI 0.35-0.75, p<0.0001), and peripheral vascular disease (HR 0.65, 95%CI 0.43-0.98, p<0.0005). CONCLUSIONS: Rotational atherectomy was undertaken in patients with higher pre-procedural risk. Medium term survival was worse among patients undergoing rotational atherectomy, and this survival disadvantage remained after correction for available adverse factors. Rotational atherectomy however remains clinically useful for patients with calcified coronary lesions.
Authors: Piotr Kübler; Wojciech Zimoch; Michał Kosowski; Brunon Tomasiewicz; Oscar Rakotoarison; Artur Telichowski; Krzysztof Reczuch Journal: Postepy Kardiol Interwencyjnej Date: 2018-03-22 Impact factor: 1.426
Authors: Rafał Januszek; Zbigniew Siudak; Artur Dziewierz; Tomasz Rakowski; Jacek Legutko; Dariusz Dudek; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2018-06-19 Impact factor: 1.426