Optimizing rotational atherectomy in high‐risk percutaneous coronary interventions: Insights from the PROTECT ΙΙ study

Cohen, Mauricio G.; Ghatak, Abhijit; Kleiman, Neal S.; Naidu, Srihari S.; Massaro, Joseph M.; Kirtane, SM Ajay J.; Moses, Jeffrey W.; Ohman, E. Magnus; Džavík, Vladimir; Palacios, Igor F.; Heldman, Alan W.; Popma, Jeffrey J.; O’Neill, William W.

doi:10.1002/ccd.25277

Cited by 39 publications

(29 citation statements)

References 29 publications

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“…Furthermore, the use of circulatory support devices, such as intra-aortic balloon pump or Impella (Abiomed Inc, Danvers, MA), may reduce the incidence of severe complications even in high-risk RA patients, such as those with left main disease or left ventricular dysfunction. 22 In institutional class, the rate of the composite outcomes in high-volume institutions was approximately half of that in low-volume institutions. As Badheka et al 23 reported that an increase in operator and institutional volume of PCI was associated with a decrease in adverse outcomes, institutional volume of RA should be the important factor for the occurrence of adverse events.…”

Section: Discussionmentioning

confidence: 97%

Incidence and Determinants of Complications in Rotational Atherectomy

Sakakura

Inohara

Kohsaka

et al. 2016

Circ: Cardiovascular Interventions

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Background— The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI). Methods and Results— The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02–1.05), impaired kidney function (OR 1.59, 95% CI 1.15–2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21–2.35), emergent PCI (OR 4.02, 95% CI 1.66–8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43–3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36–0.89). Conclusions— The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).

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Section: Discussionmentioning

confidence: 97%

Incidence and Determinants of Complications in Rotational Atherectomy

Sakakura

Inohara

Kohsaka

et al. 2016

Circ: Cardiovascular Interventions

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“…The potential mechanism for late benefit may relate to more stable procedural hemodynamics allowing for greater and more complete revascularization, including allowing for more complex PCI procedures such as rotational atherectomy. 97 No comparable randomized trial of HR-PCI with the TandemHeart device exists. Alli et al reported a series of 54 patients using the TandemHeart for HR-PCI.…”

Section: Percutaneous Mechanical Circulatory Supportmentioning

confidence: 99%

2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology–Association Canadienne de Cardiologie d'intervention)∗

Rihal

Naidu

Givertz

et al. 2015

Journal of Cardiac Failure

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244

319

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Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

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“…Interestingly, this is consistent with the late mortality reduction demonstrated in BCIS-1 and has been the cause of intense speculation. The potential mechanism for late benefit may relate to more stable procedural hemodynamics allowing for greater and more complete revascularization, including allowing for more complex PCI procedures such as rotational atherectomy [97].…”

Section: Percutaneous Mechanical Circulatory Supportmentioning

confidence: 99%

2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (Endorsed by the American heart assocation, the cardiological society of India, and sociedad latino Americana de cardiologia intervencion; Affirmation of value by the canadian association of interventional cardiology–association canadienne de cardiologie d'intervention)

Rihal

Naidu

Givertz

et al. 2015

Cathet Cardio Intervent

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Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella V R ; left atrial to femoral artery bypass pumps, specifically the is approached by other guideline developers and asked to review and consider guidelines for endorsement. Guidelines developed by external organizations will be considered for affirmation of value. The CAIC may not agree with every recommendation in such a document, but overall considers the document to be of educational value to its members. Catheterization and Cardiovascular Interventions 85:E175-E196 (2015)TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for rightsided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

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Optimizing rotational atherectomy in high‐risk percutaneous coronary interventions: Insights from the PROTECT ΙΙ study

Abstract: Patients who were treated with RA had more comorbidities, and more complex and extensive coronary artery disease. In patients with Impella, more aggressive RA use resulted in fewer revascularization events but higher incidence of periprocedural MI.

Cited by 39 publications

References 29 publications

Incidence and Determinants of Complications in Rotational Atherectomy

Incidence and Determinants of Complications in Rotational Atherectomy

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