Kenichi Sakakura1, Taku Inohara2, Shun Kohsaka2, Tetsuya Amano2, Shiro Uemura2, Hideki Ishii2, Kazushige Kadota2, Masato Nakamura2, Hiroshi Funayama2, Hideo Fujita2, Shin-Ichi Momomura2. 1. From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.). ksakakura@jichi.ac.jp. 2. From the Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan (K.S., H. Funayama, H. Fujita, S.-i.M.); and Science and Registry Committee, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan (T.I., S.K., T.A., S.U., H.I., K.K., M.N.).
Abstract
BACKGROUND: The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI). METHODS AND RESULTS: The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02-1.05), impaired kidney function (OR 1.59, 95% CI 1.15-2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21-2.35), emergent PCI (OR 4.02, 95% CI 1.66-8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43-3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36-0.89). CONCLUSIONS: The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).
BACKGROUND: The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI). METHODS AND RESULTS: The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02-1.05), impaired kidney function (OR 1.59, 95% CI 1.15-2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21-2.35), emergent PCI (OR 4.02, 95% CI 1.66-8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43-3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36-0.89). CONCLUSIONS: The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).
Authors: Michael Spartalis; Diamantis I Tsilimigras; Demetrios Moris; Christos Kontogiannis; Dimitrios C Iliopoulos; Eleftherios Spartalis Journal: Cardiol Res Date: 2018-06-06
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