Heavily calcified unprotected left main (ULM) disease continues to be a challenging situation and represent a high-risk subset for interventional cardiologist. To date, there are limited data investigating the results after rotational atherectomy (RA) in this setting. The aim of this study was to investigate the in-hospital and 1-year outcomes after RA of heavily calcified ULM lesions. A retrospective cohort analysis was performed on all calcified patients with ULM (n = 86) enrolled in the multicenter international ROTATE registry (overall patients, n = 962). End points of the study were the in-hospital and 1-year incidence of major adverse cardiovascular events (MACE): a composite of death, myocardial infarction, and target-vessel revascularization in the ULM versus non-ULM group. Patients in the ULM group were older (p = 0.01) and more frequently with diabetes (p = 0.001) compared with the non-ULM group, whereas intravascular ultrasound guidance was higher, even if not systematic, in the ULM group (p <0.001). No difference was reported between ULM versus non-ULM groups in terms of in-hospital MACE (5.8% vs 8%). At 1 year, MACE rate was higher in ULM versus non-ULM (26.4% vs 14.9%, p = 0.002) mostly driven by target-vessel revascularization (20.3% vs 12.7%, p = 0.05). Even definite/probable stent thrombosis rate was higher in the ULM group (3.9% vs 0.8%). All these events were subacute and 2/3 (75%) were fatal. In conclusion, our multicenter experience shows that RA followed by stent implantation in patients with heavily calcified ULM narrowing is feasible and associated with good in-hospital results. Patient (age and diabetes) and procedural aspects (relatively low intravascular ultrasound guidance) may affect the worse subacute mid-term prognosis in the more complex ULM group.

In-hospital and 1-year outcomes of rotational atherectomy and stent implantation in patients with severely calcified unprotected left main narrowings (from the multicenter ROTATE registry) / Ielasi, Alfonso; Kawamoto, Hiroyoshi; Latib, Azeem; Boccuzzi, Giacomo G.; Sardella, Gennaro; Garbo, Roberto; Meliga, Emanuele; D'Ascenzo, Fabrizio; Presbitero, Patrizia; Nakamura, Sunao; Colombo, Antonio. - In: THE AMERICAN JOURNAL OF CARDIOLOGY. - ISSN 0002-9149. - ELETTRONICO. - 119:9(2017), pp. 1331-1337. [10.1016/j.amjcard.2017.01.014]

In-hospital and 1-year outcomes of rotational atherectomy and stent implantation in patients with severely calcified unprotected left main narrowings (from the multicenter ROTATE registry)

SARDELLA, Gennaro;
2017

Abstract

Heavily calcified unprotected left main (ULM) disease continues to be a challenging situation and represent a high-risk subset for interventional cardiologist. To date, there are limited data investigating the results after rotational atherectomy (RA) in this setting. The aim of this study was to investigate the in-hospital and 1-year outcomes after RA of heavily calcified ULM lesions. A retrospective cohort analysis was performed on all calcified patients with ULM (n = 86) enrolled in the multicenter international ROTATE registry (overall patients, n = 962). End points of the study were the in-hospital and 1-year incidence of major adverse cardiovascular events (MACE): a composite of death, myocardial infarction, and target-vessel revascularization in the ULM versus non-ULM group. Patients in the ULM group were older (p = 0.01) and more frequently with diabetes (p = 0.001) compared with the non-ULM group, whereas intravascular ultrasound guidance was higher, even if not systematic, in the ULM group (p <0.001). No difference was reported between ULM versus non-ULM groups in terms of in-hospital MACE (5.8% vs 8%). At 1 year, MACE rate was higher in ULM versus non-ULM (26.4% vs 14.9%, p = 0.002) mostly driven by target-vessel revascularization (20.3% vs 12.7%, p = 0.05). Even definite/probable stent thrombosis rate was higher in the ULM group (3.9% vs 0.8%). All these events were subacute and 2/3 (75%) were fatal. In conclusion, our multicenter experience shows that RA followed by stent implantation in patients with heavily calcified ULM narrowing is feasible and associated with good in-hospital results. Patient (age and diabetes) and procedural aspects (relatively low intravascular ultrasound guidance) may affect the worse subacute mid-term prognosis in the more complex ULM group.
2017
acute coronary syndrome; aged; aged 80 and over; atherectomy; coronary; coronary artery disease; coronary thrombosis; female; hospital mortality; humans; incidence; male; middle aged; myocardial infarction; myocardial revascularization; plaque; atherosclerotic; postoperative complications; retrospective studies; treatment outcome; vascular calcification; drug-eluting stents; registries; cardiology and cardiovascular medicine
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In-hospital and 1-year outcomes of rotational atherectomy and stent implantation in patients with severely calcified unprotected left main narrowings (from the multicenter ROTATE registry) / Ielasi, Alfonso; Kawamoto, Hiroyoshi; Latib, Azeem; Boccuzzi, Giacomo G.; Sardella, Gennaro; Garbo, Roberto; Meliga, Emanuele; D'Ascenzo, Fabrizio; Presbitero, Patrizia; Nakamura, Sunao; Colombo, Antonio. - In: THE AMERICAN JOURNAL OF CARDIOLOGY. - ISSN 0002-9149. - ELETTRONICO. - 119:9(2017), pp. 1331-1337. [10.1016/j.amjcard.2017.01.014]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/966615
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