eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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SCImago Journal & Country Rank
1/2018
vol. 14
 
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abstract:
Original paper

Novel predictors of outcome after coronary angioplasty with rotational atherectomy. Not only low ejection fraction and clinical parameters matter

Piotr Kübler
,
Wojciech Zimoch
,
Michał Kosowski
,
Brunon Tomasiewicz
,
Oscar Rakotoarison
,
Artur Telichowski
,
Krzysztof Reczuch

Adv Interv Cardiol 2018; 14, 1 (51): 42–51
Online publish date: 2018/03/22
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Introduction
Most established risk factors after rotational atherectomy (RA) of heavily fibro-calcified lesions are associated with patients’ general risk and clinical related factors and are not specific for either coronary and culprit lesion anatomy or the RA procedure.

Aim
To assess novel predictors of poor outcome after percutaneous coronary intervention using RA in an all-comers population.

Material and methods
A total of 207 consecutive patients after RA were included in a single-center observational study. Primary endpoints were 1-year mortality and 1-year major adverse cardiac events (MACE). Secondary endpoints were angiographic and procedural success and in-hospital complications.

Results
Procedural complications occurred in 19 (8%) patients. In-hospital mortality was 1%, peri-procedural myocardial infarction (MI) was 9%, and acute stroke occurred in one patient. The 1-year MACE rate was 20% with all-cause mortality 10%, MI 10% and stroke 1%. Multivariable analysis revealed heart failure with left ventricle ejection fraction (LVEF) ≤ 35% (p = 0.02) and uncrossable lesion, as compared to undilatable lesion (p = 0.01), as independent predictors of 1-year mortality and residual SYNTAX score ≤ 8 as an independent predictor of favorable outcome (p = 0.04). Heart failure with LVEF ≤ 35% (p < 0.01) and uncrossable lesion (p = 0.04) were independent predictors of 1-year MACE.

Conclusions
The presence of a novel factor, uncrossable lesion, as compared to undilatable lesion, is associated with poor outcome, and low residual SYNTAX score ≤ 8 is associated with favorable outcome in 1-year follow-up after the RA procedure and can help in risk stratification of patients undergoing complex coronary intervention with RA.

keywords:

rotablation, calcified lesion, undilatable lesion

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