Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study

Mankerious, Nader; Hemetsberger, Rayyan; Abdel‐Wahab, Mohamed; Richardt, Gert; Allali, Abdelhakim

doi:10.1007/s40119-019-0143-4

Cited by 7 publications

(5 citation statements)

References 31 publications

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“…There may be a significant effect of RA surgery on microvascular function, which is likely to irreversibly induce myocardial damage and reduced ventricular function, ultimately leading to significant differences in long-term prognoses. [29] However, other factors may be involved in the development of MACE, and studies by Watanabe Y, Chen, Cilia L, and others suggest that MACE incidence is similarly high in patients with RA showing renal insufficiency and low EF,[35–38] and therefore, the results need to be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Angiography-derived Microcirculatory Resistance in Patients undergoing Rotational Atherectomy

Zhang,

Jin,

et al. 2023

Preprint

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BACKGROUNDRotational atherectomy (RA) is predominantly employed in the treatment of severe calcification lesions in patients with coronary atherosclerotic heart disease (CAD). Studies focusing on the assessment of postoperative microvascular dysfunction (CMD) after RA and related prognosis are scarce.AIMSwe attempted to investigate the predictive significance of coronary angiography-derived microcirculatory resistance (AMR) in patients with coronary RA.METHODSThis retrospective study analyzed the data from 114 patients who were successfully treated between January 2019 and September 2022. Coronary microcirculatory function after RA was assessed using AMR. Patients were categorized into CMD and non-CMD groups depending on a postoperative AMR of ≥2.5 mmHg-s/cm. Patients were followed up for postoperative major adverse cardiovascular events (MACE).RESULTSWe analyzed the data from 114 patients, and post-RA, the mean AMR, mean QFR, and the percentage of CMDs were significantly higher compared to those before RA. MACE occurred in 14 (12.3%) patients after a year of follow-up. A higher proportion of patients in the MACE group showed post-RA AMR of ≥2.5 mmHg-s/cm (57.1% vs. 27.0%, P=0.048). Cox regression analysis showed that AMR ≥2.5 mmHg-s/cm (HR=3.86, 95%CI. 1.28-11.63, P=0.016) and renal insufficiency (HR=9.92, 95%CI: 2.06-47.83, P=0.004) were independent predictors of MACE. Logistic regression analyses showed the length of the RA operative area and diabetes mellitus (DM) were related to post-RA CMD.CONCLUSIONIn patients with CAD treated with RA, AMR ≥2.5 mmHg-s/cm independently predicted post-RA MACE; furthermore, the operative length of RA and the comorbid DM were associated with CMD following RA.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Angiography-derived Microcirculatory Resistance in Patients undergoing Rotational Atherectomy

Zhang,

Jin,

et al. 2023

Preprint

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“…Our meta-analysis demonstrates higher rates of in-hospital TVR in the groups with severely reduced LVEF while the long term TVR rates were not different between the two groups. One study showed that TVR rates at 5 years were not affected by LVEF ( 13 ). In ORBIT II, the rate of 1-year TVR was comparable across the LVEF groups ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis

Abusnina

Mostafa²,

Al‐Abdouh³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSeverely calcified coronary lesions with reduced left ventricular (LV) function result in worse outcomes. Atherectomy is used in treating such lesions when technically feasible. However, there is limited data examining the safety and efficacy of atherectomy without hemodynamic support in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction (LVEF).ObjectiveTo evaluate the clinical outcomes of atherectomy in patient with reduced LVEF.MethodsWe searched PubMed, Cochrane CENTRAL Register and ClinicalTrials.gov (inception through July 21, 2021) for studies evaluating the outcomes of atherectomy in patients with severe LV dysfunction. We used random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI). The endpoints were in-hospital and long term all-cause mortality, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).ResultsA total of 7 studies consisting of 2,238 unique patients were included in the analysis. The median follow-up duration was 22.4 months. The risk of in-hospital all-cause mortality using atherectomy in patients with severely reduced LVEF compared to the patients with moderate reduced or preserved LVEF was [2.4vs.0.5%; RR:5.28; 95%CI 1.65–16.84; P = 0.005], the risk of long term all-cause mortality was [21 vs. 8.8%; RR of 2.84; 95% CI 1.16–6.95; P = 0.02]. In-hospital TVR risk was 2.0 vs. 0.6% (RR: 4.15; 95% CI 4.15–15.67; P = 0.04) and long-term TVR was [6.0 vs. 9.9%; RR of 0.75; 95% CI 0.39–1.42; P = 0.37]. In-hospital MI was [7.1 vs. 5.4%; RR 1.63; 95% CI 0.91–2.93; P = 0.10], long-term MI was [7.5 vs. 5.7; RR 1.74; 95%CI 0.95–3.18; P = 0.07).ConclusionOur meta-analysis suggested that the patients with severely reduced LVEF when using atherectomy devices experienced higher risk of clinical outcomes in the terms of all-cause mortality and cardiac mortality. As we know that the patients with severely reduced LVEF are inherently at increased risk of adverse clinical outcomes, this information should be considered hypothesis generating and utilized while discussing the risks and benefits of atherectomy in such high risk patients. Future studies should focus on the comparison of outcomes of different atherectomy devices in such patients. Adjusting for the inherent mortality risk posed by left ventricular dysfunction may be a strategy while designing a study.

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“…In two other studies by Watanabe et al [ 90 ] and Whiteside et al [ 91 ], slow flow was significantly higher in severely-reduced LVEF patients (defined as ≤ 35% by Watanabe et al and as ≤ 30% by Whiteside et al). A recent study found slow flow to be more than fivefold higher in patients with severely reduced LVEF (≤ 35%) as compared to preserved LVEF (≤ 55%) [ 92 ]. In another analysis done by Mankerious et al patients with severely reduced LVEF had worse acute outcome after RA as well as higher mortality on long term [ 92 ].…”

Section: Patients and Lesions Treated With Ra In The Current Practicementioning

confidence: 99%

“…A recent study found slow flow to be more than fivefold higher in patients with severely reduced LVEF (≤ 35%) as compared to preserved LVEF (≤ 55%) [ 92 ]. In another analysis done by Mankerious et al patients with severely reduced LVEF had worse acute outcome after RA as well as higher mortality on long term [ 92 ].…”

Section: Patients and Lesions Treated With Ra In The Current Practicementioning

confidence: 99%

Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials

et al. 2022

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With growing experience, technical improvements and use of newer generation drug-eluting stents (DES), recent data showed satisfactory acute and long-term results after rotational atherectomy (RA) in calcified coronary lesions. The randomized ROTAXUS and PREPARE–CALC trials compared RA to balloon-based strategies in two different time periods in the DES era. In this manuscript, we assessed the technical evolution in RA practice from a pooled analysis of the RA groups of both trials and established a link to further recent literature. Furthermore, we sought to summarize and analyze the available experience with RA in different patient and lesion subsets, and propose recommendations to improve RA practice. We also illustrated the combination of RA with other methods of lesion preparation. Finally, based on the available evidence, we propose a simple and practical approach to treat severely calcified lesions. Graphical abstract

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Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study

Cited by 7 publications

References 31 publications

Prognostic Value of Angiography-derived Microcirculatory Resistance in Patients undergoing Rotational Atherectomy

Prognostic Value of Angiography-derived Microcirculatory Resistance in Patients undergoing Rotational Atherectomy

Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis

Rotational atherectomy of calcified coronary lesions: current practice and insights from two randomized trials

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