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Sex differences in procedural and clinical outcomes following rotational atherectomy.

ABSTRACT:

Aim

Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA).

Methods and results

From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76?years vs. 72?years; p?ConclusionWomen may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long-term survival free of major adverse cardiac events was similar between males and females.

SUBMITTER: Ford TJ

PROVIDER: S-EPMC7027486 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Sex differences in procedural and clinical outcomes following rotational atherectomy.

Ford Thomas J TJ Khan Adnan A Docherty Kieran F KF Jackson Alice A Morrow Andrew A Sidik Novalia N Rocchiccioli Paul P Good Richard R Eteiba Hany H Watkins Stuart S Shaukat Aadil A Lindsay Mitchell M Robertson Keith K Petrie Mark M Berry Colin C Oldroyd Keith G KG McEntegart Margaret M

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 20190701 2

<h4>Aim</h4>Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA).<h4>Methods and results</h4>From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) a ...[more]

PMID: 31264314

Similar Datasets

Sex differences in clinical outcomes after rotational atherectomy of calcified coronary stenoses: from multicenter registry.

Project description:BackgroundRecent improvements in devices and medications may diminish the risk of adverse events following percutaneous coronary intervention (PCI) in women. However, complex calcified coronary lesions are increasingly being encountered in clinical practice, which remain challenging for contemporary PCI. Rotational atherectomy (RA) of severely calcified lesions is an option that facilitates the technical success of PCI. We aimed to examine sex differences in long-term clinical prognoses after PCI with RA in the drug-eluting stent (DES) era.Methods and resultsWe evaluated J2T ROTA registry data from 1,090 patients with severely calcified de novo coronary artery stenoses who underwent PCI using RA at 3 hospitals between 2004 and 2015. After excluding patients who received regular hemodialysis, 788 patients, including 570 men and 218 women, were ultimately analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), which included death, acute coronary syndrome (ACS), and stroke. The women were significantly older, and presented more frequently with chronic kidney disease, ACS, atrial fibrillation, lower body mass indexes, and worse lipid profiles than the men. During the observation period, MACCE occurred in 197 patients (25%) (118 deaths, 29 strokes, and 50 ACS). In the unmatched population, women had a higher MACCE rate than men (hazard ratio: 1.48, [95% confidence interval: 1.07-2.06]). However, sex was not associated with MACCE in the propensity score-matched population.ConclusionIn the DES era, differences between sexes were not observed in relation to long-term MACCE in patients undergoing PCI with RA for severely calcified coronary artery stenoses.

| S-EPMC8012285 | biostudies-literature

Ablation effect of additional low-speed rotational atherectomy following high-speed rotational atherectomy: Low-speed RA following high-speed RA.

Project description: Not available

| S-EPMC8525725 | biostudies-literature

Modifiable and unmodifiable factors associated with slow flow following rotational atherectomy.

Project description:BackgroundAlthough several groups reported the risk factors for slow flow during rotational atherectomy (RA), they did not clearly distinguish modifiable factors, such as burr-to-artery ratio from unmodifiable ones, such as lesion length. The aim of this retrospective study was to investigate the modifiable and unmodifiable factors that were associated with slow flow.MethodsWe included 513 lesions treated with RA, which were classified into a slow flow group (n = 97) and a non-slow flow group (n = 416) according to the presence or absence of slow flow just after RA. The multivariate logistic regression analysis was performed to find factors associated with slow flow.ResultsSlow flow was inversely associated with reference diameter [Odds ratio (OR) 0.351, 95% confidence interval (CI) 0.205-0.600, p<0.001], primary RA strategy (OR 0.224, 95% CI 0.097-0.513, p<0.001), short single run (≤15 seconds) (OR 0.458, 95% CI 0.271-0.776, p = 0.004), and systolic blood pressure (BP) ≥ 140 mmHg (OR 0.501, 95% CI 0.297-0.843, p = 0.009). Lesion length (every 5 mm increase: OR 1.193, 95% CI 1.093-1.301, p<0.001), angulation (OR 2.054, 95% CI 1.171-3.601, p = 0.012), halfway RA (OR 2.027, 95% CI 1.130-3.635, p = 0.018), initial burr-to-artery ratio (OR 1.451, 95% CI 1.212-1.737, p<0.001), and use of beta blockers (OR 1.894, 95% CI 1.004-3.573, p = 0.049) were significantly associated with slow flow.ConclusionsSlow flow was positively associated with several unmodifiable factors including lesion length and angulation, and inversely associated with reference diameter. In addition, slow flow was positively associated with several modifiable factors including initial burr-to-artery ratio and use of beta blockers, and inversely associated with primary RA strategy, short single run, and systolic blood pressure just before RA. Application of this information could help to improve RA procedures.

| S-EPMC8075266 | biostudies-literature

Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention.

Project description:IntroductionOur objective was to describe the contemporary outcomes of orbital atherectomy (OA) vs. rotational atherectomy (RA) use for inpatient percutaneous coronary intervention (PCI) in the United States. Data on the use of OA vs. RA in contemporary inpatient PCI are limited.MethodsWe queried the Nationwide Readmission Database (NRD) from January to November for the years 2016-2017 to identify hospitalizations of patients who underwent PCI with atherectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality.ResultsWe included 77,040 records of patients who underwent inpatient PCI with atherectomy. Of those, 71,610 (93%) had RA, and 5430 (7%) had OA. There was no significant change in the trend of using OA or RA over 2016 and 2017. OA was less utilized in patients presenting with ST-segment elevation myocardial infarction (STEMI) (4.3% vs. 46.8%, p < 0.001). In our cohort, OA was associated with lower in-hospital mortality (3.1% vs. 5%, p < 0.001) and 30-day urgent readmission (< 0.01% vs. 0.2%, p = 0.009), but a higher risk of coronary perforation (1.7% vs. 0.6%, p < 0.001) and cardiac tamponade (1% vs. 0.3%, p < 0.001) and a higher cost of index hospitalization ($28,199 vs. $23,188, p < 0.001) compared with RA.ConclusionRA remains the predominant atherectomy modality for inpatient PCI in the United States (93%). There was no change in the trend of use for either modality over the years 2016 and 2017. OA was noted to have a lower incidence of in-hospital death, but a higher risk of coronary perforation and a higher cost of index hospitalization for the overall unmatched cohorts.

| S-EPMC8126522 | biostudies-literature

Halfway rotational atherectomy for calcified lesions: Comparison with conventional rotational atherectomy in a propensity-score matched analysis.

Project description:BackgroundThe incidence of severe complications such as burr entrapment or perforation is considerable with rotational atherectomy (RA). Halfway RA is a novel strategy, in which an operator does not advance the burr to the end of a continuous calcified lesion, and performs balloon dilatation to treat the remaining part of the calcified lesion. The purpose of this study was to compare complications after halfway and conventional RA.MethodsWe included 307 consecutive lesions that were divided into a conventional RA group (n = 244) and halfway RA group (n = 63). In analysis 1, the incidence of complications was compared between the conventional RA and halfway RA groups. Propensity-score matching was used to match the intentional halfway RA and conventional RA. In analysis 2, the incidence of complications was compared between the matched conventional RA and intentional halfway RA groups.ResultsBurr entrapment (0.4%) and major perforation (0.8%) were observed in the conventional RA group, whereas there was no burr entrapment or perforation in the halfway RA group. The success rate of halfway RA was 90.5%, which required switching from halfway RA to conventional RA. The incidences of slow flow and periprocedural myocardial infarction with slow flow were similar between the intentional halfway RA and matched conventional RA groups.ConclusionsThere was no burr entrapment or vessel perforation following halfway RA. The incidences of slow flow and periprocedural myocardial infarction were similar between the intentional halfway RA and the matched conventional RA, indicating the safety of halfway RA.

| S-EPMC6611662 | biostudies-literature

Surgical removal of rotational atherectomy device.

Project description: Not available

| S-EPMC8311989 | biostudies-literature

The Impact of Intracoronary Imaging on PCI Outcomes in Cases Utilising Rotational Atherectomy: An Analysis of 8,417 Rotational Atherectomy Cases from the British Cardiovascular Intervention Society Database.

Project description:IntroductionThere is increasing evidence supporting the use of intracoronary imaging to optimize the outcomes of percutaneous coronary intervention (PCI). However, there are no studies examining the impact of imaging on PCI outcomes in cases utilising rotational atherectomy (RA-PCI). Our study examines the determinants and outcomes of using intracoronary imaging in RA-PCI cases including 12-month mortality.MethodsUsing the British Cardiac Intervention Society database, data were analysed on all RA-PCI procedures in the UK between 2007 and 2014. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural, and outcome associations with intravascular imaging.ResultsIntracoronary imaging was used in 1,279 out of 8,417 RA-PCI cases (15.2%). Baseline covariates associated with significantly more imaging use were number of stents used, smoking history, previous CABG, pressure wire use, proximal LAD disease, laser use, glycoprotein inhibitor use, cutting balloons, number of restenosis attempted, off-site surgery, and unprotected left main stem (uLMS) PCI. Adjusted rates of in-hospital major adverse cardiac/cerebrovascular events (IH-MACCE), its individual components (death, peri-procedural MI, stroke, and major bleed), or 12-month mortality were not significantly altered by the use of imaging in RA-PCI. However, subgroup analysis demonstrated a signal towards reduction in 12-month mortality in uLMS RA-PCI cases utilising intracoronary imaging (OR 0.67, 95% CI 0.44-1.03).ConclusionsIntracoronary imaging use during RA-PCI is associated with higher risk of baseline and procedural characteristics. There were no differences observed in IH-MACCE or 12-month mortality with intracoronary imaging in RA-PCI.

| S-EPMC8941577 | biostudies-literature

Clinical Outcome of Rotational Atherectomy in Calcified Lesions in Korea-ROCK Registry.

Project description:Background and Objectives: Data is still limited regarding clinical outcomes of rotational atherectomy (RA) after percutaneous coronary intervention. We sought to evaluate clinical outcomes of RA. Materials and Methods: This multi-center registry enrolled patients who underwent RA during PCI from nine tertiary centers in Korea between January 2010 and October 2019. The primary endpoint was target-vessel failure (TVF; the composite outcome of cardiac death, target-vessel spontaneous myocardial infarction, or target-vessel revascularization). Results: Of 540 patients (583 lesions), the mean patient age was 71.4 ± 0.4 years, 323 patients (59.8%) were men, and 305 patients (56.5%) had diabetes mellitus. Technical success rate was 96.4%. In-hospital major adverse cerebral and cardiac events occurred in 63 cases (10.8%). At 1.5 years, 72 (16.0%) of TVFs were occurred. We evaluated independent predictors of TVF, which included current smoker (hazard ratio (HR), 1.92; 95% confidence interval (CI), 1.17-3.16; p = 0.01), chronic renal disease (HR, 1.87; 95% CI, 1.14-3.08; p = 0.013), history of cerebrovascular attack (HR, 2.14; 95% CI, 1.24-3.68; p = 0.006), left ventricle ejection fraction (HR, 0.98; 95% CI, 0.97-0.999; p = 0.037), and left main disease (HR, 1.94; 95% CI, 1.11-3.37; p = 0.019). Conclusions: From this registry, we demonstrated acceptable success rates, in-hospital and mid-term clinical outcomes of RA in the DES era.

| S-EPMC8303478 | biostudies-literature

Covered Stents for the Percutaneous Management of Delayed Coronary Wall Rupture Following Subadventitial Rotational Atherectomy.

Project description:We present herein the case of a delayed covered coronary wall rupture occurring as a rare complication of rotational atherectomy performed in the subintimal space after antegrade dissection reentry for percutaneous recanalization of a long and heavily calcified left anterior descending chronic total occlusion, which was successfully managed percutaneously with the implantation of 2 covered stents. (Level of Difficulty: Intermediate.).

| S-EPMC8304589 | biostudies-literature

Intravascular ultrasound-factors associated with slow flow following rotational atherectomy in heavily calcified coronary artery.

Project description:Intravascular ultrasound (IVUS) can provide useful information in patients undergoing complex percutaneous coronary intervention with rotational atherectomy (RA). The association between IVUS findings and slow flow following rotational atherectomy (RA) has not been investigated, although slow flow has been shown to be an unfavorable sign with worse outcomes. The aim of this study was to determine the IVUS-factors associated with slow flow just after RA. We retrospectively enrolled 290 lesions (5316 IVUS-frames) with RA, which were divided into the slow flow group (n = 43 with 1029 IVUS-frames) and the non-slow flow group (n = 247 with 4287 IVUS-frames) based on the presence of slow flow. Multivariate regression analysis assessed the IVUS-factors associated with slow flow. Slow flow was significantly associated with long lesion length, the maximum number of reverberations [odds ratio (OR) 1.49; 95% confidence interval (CI) 1.07-2.07, p = 0.02] and nearly circumferential calcification at minimal lumen area (MLA) (≥ 300°) (OR, 2.21; 95% CI 1.13-4.32; p = 0.02). According to the maximum number of reverberations, the incidence of slow flow was 2.2% (n = 0), 11.9% (n = 1), 19.5% (n = 2), 22.5% (n = 3), and 44.4% (n = 4). In conclusion, IVUS findings such as longer lesion length, the maximum number of reverberations, and the greater arc of calcification at MLA may predict slow flow after RA. The operators need to pay more attention to the presence of reverberations to enhance the procedure safety.

| S-EPMC8983755 | biostudies-literature

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