Short-term and long-term outcomes of bailout versus planned coronaryrotational atherectomy.

Zhanru Qi,Zhonghai Wei ,Jingmei Zhang,Lian Wang,Qing Dai,Jun Xie,Hongyan Zheng,Jie Song

doi:10.31083/j.rcm.2020.02.36

Zhanru Qi, Zhonghai Wei + Show 6 more

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https://doi.org/10.31083/j.rcm.2020.02.36

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Abstract

The goal of this study was to compare in-hospital and long-term events between bailout rotational atherectomy (RA) and planned RA. In this retrospective study, All patients who underwent percutaneous coronary intervention (PCI) using RA at Nanjing Drum Tower Hospital from November 2011 to December 2018 were enrolled in this study. Planned RA was defined as RA performed immediately before balloon pre-dilation, while bailout RA was defined as RA after failure to expand the balloon or perform any other procedure. In-hospital and long-term major adverse cardiac events (MACE, defined as cardiac mortality, myocardial infarction (MI), target vessel revascularization (TVR) and stroke) were compared between the two groups. After statistical analysis, a total of 211 patients underwent PCI with RA during the study period: 153 in the planned RA group, and 58 in the bailout group. The incidence of coronary dissection was significantly higher in the bailout RA group than in the planned RA group (22.4% vs. 6.5%, P = 0.001). However, no significant difference in in-hospital MACE was found between the two groups (12.1% vs. 13.7%, P = 0.752). There was no difference in all-cause mortality (9.1% vs. 12.5%, P = 0.504) or long-term MACE (13.8% vs. 17.1%, P = 0.560) between the groups. Bailout RA was associated with a significantly longer procedural time (139.86 ± 56.24 min vs. 105.56 ± 36.71 min, P < 0.001) than planned RA. Therefore, compared with bailout RA, planned RA is associated with shorter procedural time and reduced incidence of coronary dissection, with no difference in MACE or mortality.

Highlights

As a result of the aging population in China, more patients with coronary heart disease (CHD) are undergoing percutaneous coronary intervention (PCI) than ever before
Not all rotational atherectomy (RA) procedures are performed as a planned procedure directly after a coronary angiography (CAG) examination, and a considerable portion of RA procedures are performed after failed balloon expansion
3.1 Baseline clinical characteristics Both groups were similar in age, sex, and cardiac comorbidities such as hypertension, diabetes, hyperlipidemia, smoking history, or left ventricular ejection fraction (LVEF) (Table 1)

Summary

Introduction

As a result of the aging population in China, more patients with coronary heart disease (CHD) are undergoing percutaneous coronary intervention (PCI) than ever before. PCI is being performed in patients with heavy calcified coronary lesions, which can change vascular wall compliance, add to the difficulty of stent placement, and increase the risk of postoperative complications and death (Arora et al, 2016). Coronary rotational atherectomy (RA) plays an important role in PCI of heavy calcified coronary lesions by using high-speed rotating burrs to reduce plaque volume and modify plaque morphology (Kuriyama et al, 2011). The short- and long-term outcomes of planned RA versus bailout RA have not been previously studied. We sought to compare in-hospital and long-term outcomes between planned RA and bailout RA performed at our institution

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