Abstract 13968: Regional Calcified Plaque Score evaluated by Computed Tomographic Angiography for Indicating the Addition of Rotational Atherectomy in Patients With Percutaneous Coronary Intervention

Abstract

Introduction: Rotational atherectomy (Rota) has been proposed as the best strategy relative to all other percutaneous coronary interventions (PCI) in complex and severely calcified lesions, and the examination of calcified plaque conditions is necessary to determine whether Rota is indicated. Multidetector computed tomography coronary angiography (CTA) can provide non-invasive assessment of calcified plaques with obstructive coronary artery disease. Hypothesis: We hypothesized that regional coronary artery calcium score (CAC) of the target lesion on CTA would aid in deciding whether subsequent intervention strategies should be pursued, including Rota. Methods: Lesion CAC and calcified plaque patterns measured in the target lesion on CTA were evaluated regionally with quantitative coronary analysis (QCA) on angiography for predicting Rota treatment in 116 consecutive patients (168 target lesions) who had undergone their first PCI (mean age ± standard deviations: 68 ± 10 years, females: 19.8%). Results: PCI without Rota was performed successfully in 105 patients (154 lesions), and Rota treatment was added in 11 patients (14 lesions). The patients with Rota had significantly higher SYNTAX score (p=0.007) and CAC than those without Rota (p<0.001). Concerning the target lesions, the primary factors associated with the implementation of Rota included a lesion length of ≥20 mm and a diameter stenosis of ≥74% on QCA (indicates a complex lesion), and a lesion CAC ≥453 and one calcification arc ≥270 on cross-section images on CTA (indicates a severely calcified pattern). After adjustment for potential confounding variables, high lesion CAC (≥453) remains a powerful predictor of Rota treatment with odds ratios of 31.3 [95% confidence interval 2.8-345, p=0.005] (sensitivity: 92.9% and specificity: 88.3%). Conclusions: The lesion CAC as a simple marker of calcified plaque condition in target lesion is useful for indicating the addition of Rota in patients with PCI.