Long‐term clinical outcome of rotational atherectomy followed by drug‐eluting stent implantation in complex calcified coronary lesions

Abdel‐Wahab, Mohamed; Baev, Radoy; Dieker, Patrick; Kassner, Guido; Khattab, Ahmed A.; Töelg, Ralph; Sulimov, Dmitriy S.; Geist, Volker; Richardt, Gert

doi:10.1002/ccd.24367

Cited by 116 publications

(103 citation statements)

References 22 publications

(24 reference statements)

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“…On the other hand, we have also proven that long‐term FU of our high‐risk, elderly RA stented patients yield acceptable all‐cause mortality data as compared with that in other databases 1, 2, 3, 4, 5, 6.…”

Section: Discussionmentioning

confidence: 51%

“…Benezet et al 1 published total cardiac death, target lesion revascularization, and MI incidence rates of up to 4.9%, 3.9%, and 8.8%, respectively, at 15 months FU with RA stenting using DES devices. Abdel‐Wahab et al 2 also found promising long‐term results following RA stenting with DES systems in a large patient database. Despite all these promising trials, however, ACS and high‐risk patients were either excluded from different studies or were not sufficiently examined.…”

Section: Discussionmentioning

confidence: 91%

“…Two more independent clinical predictors of mortality were observed in our database: decreased left ventricular EF and diabetes. Decreased left ventricular EF has previously been found to be an independent risk factor of mortality following conventional PCI and RA stenting 2, 18. In fact, an inverse relationship has been noted in heart failure between left ventricular EF and mortality.…”

Section: Discussionmentioning

confidence: 97%

“…Rotational atherectomy (RA) has emerged as a method of solving such coronary lesions, but is mainly available in tertiary, high‐volume centers. RA with subsequent bare metal stent (BMS) or drug‐eluting stent (DES) implantation improves the clinical outcomes of patients with calcified coronary artery disease (CAD) 1, 2, 3, 4, 5, 6, 7, 8 and procedure‐related major adverse cardiac events (MACE) along with mid‐ to long‐term mortality have all been at acceptable levels. Nonetheless, RA is still a technically demanding method requiring scrupulous execution, which may explain why it is seldom used in everyday interventional practice 9, 10, 11.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, in the available databases, mainly low‐ or moderate‐risk subjects have been investigated 1, 2, 3, 4, 5, 6, 7, 8. Data regarding the survival after RA stenting in high‐risk patients with diffuse CAD presenting with extensive co‐morbidities have not yet been sufficiently investigated.…”

Section: Introductionmentioning

confidence: 99%

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Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

Édes

Ruzsa

Szabó

et al. 2015

Cathet Cardio Intervent

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ObjectivesOur aim was to assess the procedural success and determine the clinical predictors of postprocedure mortality, following rotational atherectomy (RA) and stenting in high‐risk patients.BackgroundRA is mainly used to facilitate stenting in complex lesions. Outcomes involving RA and stenting have been investigated, yet high‐risk patients have not been adequately described.MethodsData of 218 consecutive patients who underwent RA were evaluated in a prospective register. Primary endpoints were the angiographic success and long‐term mortality. Secondary endpoints were procedural success, consumption of the angioplasty equipment, and periprocedural major adverse cardiac events. The impact of the relevant angiographic and clinical characteristics on long‐term mortality was analyzed using uni‐ and multivariate Cox regression analysis.ResultsMean age of the patients was 70 ± 8.2 years, diabetes was present in 44%, and chronic renal failure in 29%. Prior myocardial infarction and three‐vessel disease amounted to 42.2% and 32.6%, respectively. Altogether, 52.8% of patients underwent RA after a failed, non‐RA intervention attempt, and 30.7% of cases presented as acute coronary syndromes. Angiographic success was 100%, and all patients received stents after RA. Periprocedural major adverse cardiac events occurred in five (2.3%) patients. Postprocedural death was investigated, with a mean follow‐up of 36 months. Mortality amounted to 37.2%. Multivariate analysis revealed that left ventricular ejection fraction < 50%, glomerular filtration rate < 60 ml/min, cardiogenic shock, and diabetes were the only independent mortality predictors.ConclusionsWe have found that RA and stenting is feasible and viable in an elderly high‐risk population, with exceptional procedural success and acceptable long‐term results. © 2015 Wiley Periodicals, Inc.

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