Teruo Sekimoto1, Yasushi Akutsu2, Yuji Hamazaki1, Koshiro Sakai1, Ryota Kosaki1, Hiroyuki Yokota1, Hiroaki Tsujita1, Shigeto Tsukamoto1, Kyoichi Kaneko1, Masayuki Sakurai1, Yusuke Kodama1, Hui-Ling Li1, Takehiko Sambe3, Katsuji Oguchi4, Naoki Uchida3, Shinichi Kobayashi5, Atsushi Aoki6, Takehiko Gokan7, Youichi Kobayashi1. 1. Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan. 2. Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan; Department of Internal Medicine (Cardiology), Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Karasuyama Hospital, Japan. Electronic address: hzn01233@s02.itscom.net. 3. Department of Pharmacology, Showa University School of Medicine, Japan; Department of Internal Medicine (Cardiology), Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Karasuyama Hospital, Japan. 4. Department of Pharmacology, Showa University School of Medicine, Japan. 5. Department of Internal Medicine (Cardiology), Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Karasuyama Hospital, Japan. 6. Department of Cardiovascular Surgery, Showa University School of Medicine, Japan. 7. Department of Radiology, Showa University School of Medicine, Japan.
Abstract
BACKGROUND: Rotational atherectomy (rotablation) has been proposed as a potentially superior strategy for percutaneous coronary intervention (PCI) in complex and severely calcified lesions. OBJECTIVES: We hypothesized that a per-lesion coronary artery calcium score determined by multidetector computed tomography (MDCT) would be useful for predicting the requriement for rotablation during PCI. METHODS: MDCT was performed in patients with stable angina pectoris who were scheduled for first PCI. In 116 consecutive subjects (168 target lesions) with successful PCI, MDCT and quantitative coronary angiography (QCA) data were retrospectively evaluated regarding their ability to predict rotablation. RESULTS: PCI without rotablation was performed in 105 patients (154 lesions), and rotablation was added in 11 patients (14 lesions). Patients with rotablation had significantly higher SYNTAX scores (p = 0.007) and total calcium scores (p < 0.001) than those without rotablation. Per-lesion, a lesion length ≥20 mm and diameter stenosis ≥74% on QCA as well as a per-lesion calcium score ≥453 and calcification arc ≥270 in MDCT predicted rotablation. After adjustment for potential confounding variables, a high per-lesion calcium score was an independent predictor of rotablation (odds ratio 31.3, 95% confidence interval 2.8-345, p = 0.005, sensitivity 93% and specificity 88%). CONCLUSION: The extent of target lesion calcification in MDCT, a simple marker of calcified plaque, is useful for predicting the need for rotablation during PCI.
BACKGROUND: Rotational atherectomy (rotablation) has been proposed as a potentially superior strategy for percutaneous coronary intervention (PCI) in complex and severely calcified lesions. OBJECTIVES: We hypothesized that a per-lesion coronary artery calcium score determined by multidetector computed tomography (MDCT) would be useful for predicting the requriement for rotablation during PCI. METHODS: MDCT was performed in patients with stable angina pectoris who were scheduled for first PCI. In 116 consecutive subjects (168 target lesions) with successful PCI, MDCT and quantitative coronary angiography (QCA) data were retrospectively evaluated regarding their ability to predict rotablation. RESULTS: PCI without rotablation was performed in 105 patients (154 lesions), and rotablation was added in 11 patients (14 lesions). Patients with rotablation had significantly higher SYNTAX scores (p = 0.007) and total calcium scores (p < 0.001) than those without rotablation. Per-lesion, a lesion length ≥20 mm and diameter stenosis ≥74% on QCA as well as a per-lesion calcium score ≥453 and calcification arc ≥270 in MDCT predicted rotablation. After adjustment for potential confounding variables, a high per-lesion calcium score was an independent predictor of rotablation (odds ratio 31.3, 95% confidence interval 2.8-345, p = 0.005, sensitivity 93% and specificity 88%). CONCLUSION: The extent of target lesion calcification in MDCT, a simple marker of calcified plaque, is useful for predicting the need for rotablation during PCI.