Clinical Outcomes of Sirolimus-Eluting Stenting After Rotational Atherectomy

Abstract

PCIAll procedures were performed according to standard techniques, and all decisions concerning the strategy to be used were made by an experienced interventional cardiologist Received April 9, 2009; revised manuscript received July 7, 2009; accepted July 24, 2009 The efficacy of drug-eluting stents after rotational atherectomy (ROTA) has not been clarified. Methods and Results:The 704 consecutive patients who underwent percutaneous coronary intervention (PCI) with a sirolimus-eluting stent (SES) (79 with and 625 without ROTA) were enrolled. The 2-year clinical outcome of these patients was compared with that of a group of 1,123 consecutive patients treated with bare-metal stents (BMS) (144 with and 979 without ROTA). At 2 years after index PCI, the use of SES after ROTA was associated with a lower crude incidence of major adverse cardiac events (MACE) than were BMS after ROTA (30.1% vs 43.1%, P=0.024). The difference was mainly derived from the reduction in target lesion revascularization (TLR) (25.0% vs 39.1%, P=0.022). After adjusting for confounders, ROTA-SES was associated with a reduction in MACE and TLR, with a similar hazard ratio to the non-ROTA group only with SES implantation. In a subgroup of dialysis patients, the incidence of TLR after ROTA with SES and BMS was similarly high. Conclusions:The use of SES after ROTA is an appropriate method for selected hard lesions, but has a limited effect in dialysis patients, even after lesion preparation with ROTA. (Circ J 2009; 73: 2042 -2049

Impact of Platelet Reactivity to Adenosine Diphosphate Before Implantation of Drug-Eluting Stents on Subsequent Adverse Cardiac Events in Patients With Stable Angina

“…The prevalence of TLR at 1 year after SES implantation after rotational atherectomy in consecutive patients including dialysis patients at our hospital was high (21.2%). 10 Sawada et al 41 stated that the overall prevalence of TLR after DES implantation in Japanese patients was 17%. Third, data were collected under oral administration of ticlopidine because we did not have permission to use clopidogrel in patients with stable angina on a health insurance system in Japan.…”

Clinical Characteristics and Long-Term Outcomes of Rotational Atherectomy ― J2T Multicenter Registry ―

“…[7][8][9][10][11] This increase in adverse event rates is thought to be associated with a higher patient risk profile and the complexity of the coronary anatomy, rather than the specific procedure itself. 12 Patient and lesion characteristics are thus important for the long-term outcome of RA for heavily calcified lesions.…”

Role of Rotational Atherectomy in Percutaneous Coronary Interventions in Elderly

“…In some series, compared to BMS, DES also results in lower MACE rates. This is primarily secondary to lower rates of Target Lesion Revascularization (TLR) [4,[23][24][25].…”