Clinical Outcome of Rotational Atherectomy in Calcified Lesions in Korea-ROCK Registry
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Procedure
2.3. Study Outcomes
2.4. Statistical Analyses
3. Results
3.1. Baseline Patient, Lesion, and Procedural Characteristics
3.2. Procedural Outcomes
3.3. Clinical Outcomes
3.4. Subgroup Analysis among Patients that Received PCI Successfully According to Clinical Presentation
4. Discussion
Limitation
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Mean ± SD, n (%) or Median (IQR) (n = 540) |
---|---|
Age (years) | 71.4 ± 0.4 |
Male | 323 (59.8) |
BMI (kg/m2) | 24.2 ± 3.9 |
Diabetes mellitus | 305 (56.5) |
Insulin use | 72 (13.3) |
Hypertension | 415 (76.9) |
Hyperlipidemia | 235 (43.5) |
Current smoker | 103 (19.1) |
Clinical presentation | |
Silent ischemia | 37 (6.9) |
Stable angina | 176 (32.6) |
Unstable angina | 175 (32.4) |
NSTEMI | 133 (24.6) |
STEMI | 19 (3.5) |
Presented as ACS | 327 (60.6) |
Chronic kidney disease | 96 (17.8) |
Prior MI | 66 (12.2) |
Prior PCI | 138 (25.6) |
Prior CABG | 24 (4.4) |
Peripheral vascular disease | 39 (7.2) |
History of heart failure | 77 (14.3) |
Atrial fibrillation | 49 (9.1) |
LV EF, % | 53.0 ± 13.4 |
Medication at discharge | |
Aspirin | 529 (98.0) |
P2Y12 Inhibitor | 530 (98.1) |
DAPT | 518 (95.9) |
B-blocker | 381 (70.6) |
ACEI/ARB | 341 (63.1) |
Statin | 499 (92.4) |
NOAC | 17 (2.9) |
Characteristics | Mean ± SD, n (%) or Median (IQR) (n = 583) |
---|---|
ACC/AHA classification | |
Type B2/C | 59 (10.1)/480 (82.4) |
Target vessel | |
LAD | 384 (65.9) |
LCX | 59 (10.1) |
RCA | 140 (24.0) |
LM disease | 82 (14.1) |
Multivessel disease | 467 (80.1) |
Femoral approach | 323 (55.4) |
Treatment type | |
POBA | 6 (1.0) |
DEB | 17 (2.9) |
Stent implantation | 548 (94.0) |
Failure | 12 (2.0) |
IVUS or OCT | 268 (46.0) |
Escalation of Burr | 91 (15.6) |
Maximum Burr size, mm | |
1.25 | 157 (26.9) |
1.5 | 308 (52.9) |
1.75 | 107 (18.4) |
2.0 | 10 (1.7) |
2.5 | 1 (0.2) |
Access size | |
5 F | 5 (0.9) |
6 F | 215 (36.9) |
7 F | 326 (55.9) |
8 F | 37 (6.3) |
Total number of stents | 2.38 ± 1.18 |
Number of stents (target-vessel) | 1.66 ± 0.68 |
Mean stent diameter, mm (target-vessel) | 2.99 ± 0.38 |
Total stent length, mm | 69.02 ± 35.66 |
Stent length, mm (target-vessel) | 49.48 ± 21.13 |
Mean ± SD, n (%) or Median (IQR) | |
---|---|
Technical success | 562 (96.4) |
Procedural success | 508 (87.1) |
Contrast amount, mL | 210 (150–300) |
Procedure time, min | 63.4 (45.0–97.0) |
Radiation dose, mGy | 2685 (1512–4800) |
In-hospital MACCEs | 62 (10.6) |
In-hospital death | 11 (1.9) |
Procedure-related myocardial infarction | 46 (7.9) |
Urgent revascularization | 9 (1.5) |
In-hospital stroke | 2 (0.3) |
Procedural Complications | |
Cardiac tamponade requiring intervention | 3 (0.5) |
Coronary perforation | 11 (1.9) |
Severe coronary dissection immediate after RA procedure * | 35 (6.0) |
Temporary pacemaker during RA procedure | 19 (3.3) |
Contrast-Induced Nephropathy | 19 (3.3) |
In-hospital bleeding | 27 (4.6) |
Univariate | Multivariate * | |||
---|---|---|---|---|
Variables | HR (95% CI) | p | HR (95% CI) | p |
Age | 0.99 (0.97–1.01) | 0.43 | ||
Male gender | 1.12 (0.74–1.70) | 0.59 | ||
Current smoker | 1.67 (1.06–2.65) | 0.028 | 1.92 (1.17–3.16) | 0.01 |
HTN | 0.97 (0.60–1.57) | 0.91 | ||
Diabetes mellitus | 1.39 (0.91–2.11) | 0.13 | ||
Hyperlipidemia | 0.59 (0.38–0.92) | 0.018 | ||
Chronic kidney disease | 2.12 (1.34–3.35) | 0.001 | 1.87 (1.14–3.08) | 0.013 |
Family history of CAD | 1.50 (0.37–6.11) | 0.57 | ||
Prior MI | 0.60 (0.28–1.29) | 0.19 | ||
Prior PCI | 1.10 (0.69–1.73) | 0.70 | ||
Prior CABG | 0.91 (0.33–2.48) | 0.85 | ||
History of cerebrovascular attack | 2.15 (1.32–3.50) | 0.002 | 2.14 (1.24–3.68) | 0.006 |
Peripheral artery disease | 1.69 (0.88–3.25) | 0.12 | ||
Atrial fibrillation | 1.54 (0.82–2.90) | 0.18 | ||
LV EF (%) | 0.98 (0.96–0.99) | 0.003 | 0.98 (0.97–0.999) | 0.037 |
Presented as ACS | 1.61 (1.03–2.51) | 0.035 | 1.54 (0.95–2.51) | 0.08 |
MVD | 0.95 (0.56–1.61) | 0.86 | ||
LM disease | 1.68 (1.02–2.75) | 0.041 | 1.94 (1.11–3.37) | 0.019 |
Mean stent diameter per target vessel | 0.97 (0.55–1.71) | 0.92 | ||
Total number of stents | 1.23 (1.04–1.44) | 0.014 | 1.19 (0.996–1.41) | 0.06 |
Total stent length | 1.007 (1.001–1.012) | 0.026 |
All Study Population | Era | Technical Success, % | Follow-Up Duration | All-Cause Death, % | TVR, % | TLR, % | ST, % | CVA, % | |
---|---|---|---|---|---|---|---|---|---|
Okai et al. [1] | 1090 | DES | 96.2 | 3.8 (IQR 1.9–6.1) years | 24.2 | 21.4 | 16.2 | 1.3 | 4.7 |
Kawamoto et al. [20] | 985 | 8.8% BMS91.2% DES | 99.1 | 2 years | 9.5 | 19.8 | 16.6 | 1.8 | 1.0 |
Cortese et al. [21] | 1397 | 17% POBA40.7% BMS42% DES | 99.3 | 2.4 (0.8–5.7) years | 6.4 | - | 11.7 | 1.4 | - |
Rathore et al. [19] | 516 | 24.2% BMS75.8% DES | 99.4 | 6–9 months | - | - | 14.4 | 0.8 * | - |
Abdel-Wahab et al. [12] | 205 | DES | 98.0 | 1.3 (0.08–7) years | 9.0 | 11.2 | 7.9 | 1.0 | - |
Our study ** | 540 | DES | 96.4 | 1.5 (IQR 0.7–2.9) years | 8.4 | 9.8 | 8.2 | 1.2 | 2.0 |
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Lee, K.; Jung, J.-h.; Lee, M.; Kim, D.-W.; Park, M.-W.; Choi, I.-J.; Lee, J.-H.; Lee, J.-H.; Lee, S.-R.; Lee, P.-H.; et al. Clinical Outcome of Rotational Atherectomy in Calcified Lesions in Korea-ROCK Registry. Medicina 2021, 57, 694. https://doi.org/10.3390/medicina57070694
Lee K, Jung J-h, Lee M, Kim D-W, Park M-W, Choi I-J, Lee J-H, Lee J-H, Lee S-R, Lee P-H, et al. Clinical Outcome of Rotational Atherectomy in Calcified Lesions in Korea-ROCK Registry. Medicina. 2021; 57(7):694. https://doi.org/10.3390/medicina57070694
Chicago/Turabian StyleLee, Kyusup, Ji-hoon Jung, Myunhee Lee, Dae-Won Kim, Mahn-Won Park, Ik-Jun Choi, Jae-Hwan Lee, Jang-Hoon Lee, Sang-Rok Lee, Pil-Hyung Lee, and et al. 2021. "Clinical Outcome of Rotational Atherectomy in Calcified Lesions in Korea-ROCK Registry" Medicina 57, no. 7: 694. https://doi.org/10.3390/medicina57070694