Acute- and Long-term Outcomes of Rotational Atherectomy followed by Cutting Balloon versus Plain Balloon before Drug-Eluting Stent Implantation for Calcified Coronary Lesions
Background: Coronary calcification is a major determinant of stent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy (RA) followed by cutting balloon (CB) versus plain balloon before drug-eluting stent implantation for calcified coronary lesions. Methods: From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA: RA+CB group (n = 75) and RA+plain balloon group (n = 52). Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term (>1 year) outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis. Results: The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA+CB group than in the RA+plain balloon group (1.57 +/- 0.46 mm vs. 1.10 +/- 0.40 mm, t = 4.123, P < 0.001). The final lumen diameter was also larger in the RA+CB group compared to that in the RA group (2.81 +/- 0.41 mm vs. 2.60 +/- 0.25 mm, t = 2.111, P = 0.039). Moreover, patients receiving RA and CB tended to have larger final lumen gain (2.15 +/- 0.48 mm vs. 1.95 +/- 0.47 mm, t = 1.542, P = 0.132). Multivariate Cox regression analysis indicated that the strategy of RA+CB was a significant protective factor against long-term (>1 year) in-stent restenosis (hazard ratio: 0.136, 95% confidence interval: 0.020-0.936, P = 0.043). Conclusions: In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.
基金：
National Natural Science Foundation of ChinaNational Natural Science Foundation of China [81670222, 81600209]; Beijing Municipal Science and Technology CommissionBeijing Municipal Science & Technology Commission [Z181100001718060]; Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support [ZYLX201710]; Beijing Municipal Administration of Hospitals' Youth Program [QML20160605]; Beijing Municipal Administration of Hospitals Incubating Program [PX2016048]; Beijing Municipal Organization Department [2016000021469G194]
第一作者机构：[1]Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
通讯作者：
通讯机构：[1]Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China[*1]Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
推荐引用方式(GB/T 7714)：
Ai Hui,Wang Xiao,Suo Min,et al.Acute- and Long-term Outcomes of Rotational Atherectomy followed by Cutting Balloon versus Plain Balloon before Drug-Eluting Stent Implantation for Calcified Coronary Lesions[J].CHINESE MEDICAL JOURNAL.2018,131(17):2025-+.doi:10.4103/0366-6999.239299.
APA：
Ai, Hui,Wang, Xiao,Suo, Min,Liu, Jing-Chen,Wang, Cheng-Gang...&Nie, Shao-Ping.(2018).Acute- and Long-term Outcomes of Rotational Atherectomy followed by Cutting Balloon versus Plain Balloon before Drug-Eluting Stent Implantation for Calcified Coronary Lesions.CHINESE MEDICAL JOURNAL,131,(17)
MLA：
Ai, Hui,et al."Acute- and Long-term Outcomes of Rotational Atherectomy followed by Cutting Balloon versus Plain Balloon before Drug-Eluting Stent Implantation for Calcified Coronary Lesions".CHINESE MEDICAL JOURNAL 131..17(2018):2025-+
