Comparison of patients undergoing protected high risk percutaneous coronary intervention using either intravascular lithotripsy or rotational atherectomy.

IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Frontiers in Cardiovascular Medicine Pub Date : 2024-11-29 eCollection Date: 2024-01-01 DOI:10.3389/fcvm.2024.1451229
Tobias T Krause, Shazia S Afzal, Anida Gjata, Michael Lindner, Louai Saad, Mirjam Steinbach, Rashad Zayat, Assad Haneya, Nikos Werner, Juergen Leick
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引用次数: 0

Abstract

Background: Treating heavily calcified vessels is a challenging task in patients with an impaired left ventricular ejection fraction. Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients in high-risk percutaneous coronary intervention (HRPCI).

Methods: In this retrospective registry, we investigated 25 patients undergoing a protected HRPCI receiving either intravascular lithotripsy (IVL + pMCS; n = 11) or rotational atherectomy (RA + pMCS; n = 14). The primary endpoint was defined as peri-interventional hemodynamic stability. The secondary endpoint was defined as major adverse cardiac events (MACE).

Results: Patients in the IVL + pMCS group had a significantly higher mean arterial pressure (MAP) at the end of the procedure (p = 0.04). However, the Δ-change in MAP was not significant [-12 mmHg (±20.3) vs. -16.1 mmHg (±23.9), p = 0.709]. The proportion of patients requiring post-interventional catecholamines was significantly lower in the IVL + pMCS group (p = 0.02). The Δ-change in Syntax Score was not significant between groups (IVL + pMCS -22 (±5.8) vs. RA + pMCS -21.2 (±7.6), p = 0.783). MACE did occur less in the group of IVL + pMCS (0% vs. 20%, p = 0.046). Patients with pMCS insertion as a bailout strategy had a higher probability for in-hospital death (p < 0.001) and the occurrence of the slow-reflow phenomenon was associated with long-term mortality (p = 0.021) in the cox regression analysis.

Conclusions: In our cohort patients in the IVL + pMCS group were hemodynamically more stable which led to a lower rate of catecholamine usage. pMCS as a bailout strategy was associated with in-hospital death and the occurrence of the slow reflow phenomenon with all-cause mortality during follow-up.

使用血管内碎石术或旋转动脉粥样硬化切除术对接受受保护的高风险经皮冠状动脉介入治疗的患者进行比较。
背景:对于左心室射血分数受损的患者,治疗严重钙化血管是一项具有挑战性的任务。经皮机械循环支持(pMCS)越来越多地用于高危经皮冠状动脉介入治疗(HRPCI)患者。方法:在这项回顾性登记中,我们调查了25例接受保护性HRPCI的患者,这些患者接受血管内碎石术(IVL + pMCS;n = 11)或旋转动脉粥样硬化切除术(RA + pMCS;n = 14)。主要终点定义为介入期血流动力学稳定性。次要终点定义为主要不良心脏事件(MACE)。结果:IVL + pMCS组患者在手术结束时平均动脉压(MAP)显著升高(p = 0.04)。然而,MAP中的Δ-change无显著性差异[-12 mmHg(±20.3)vs -16.1 mmHg(±23.9),p = 0.709]。IVL + pMCS组介入后需要儿茶酚胺的患者比例显著降低(p = 0.02)。语法评分Δ-change组间差异无统计学意义(IVL + pMCS -22(±5.8)vs RA + pMCS -21.2(±7.6),p = 0.783)。IVL + pMCS组MACE发生率较低(0% vs. 20%, p = 0.046)。cox回归分析显示,将pMCS插入作为救助策略的患者住院死亡概率更高(p p = 0.021)。结论:在我们的队列中,IVL + pMCS组患者血流动力学更稳定,导致儿茶酚胺使用率更低。在随访期间,pMCS作为一种救助策略与院内死亡、慢血流现象的发生及全因死亡率相关。
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来源期刊
Frontiers in Cardiovascular Medicine
Frontiers in Cardiovascular Medicine Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.80
自引率
11.10%
发文量
3529
审稿时长
14 weeks
期刊介绍: Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers? At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
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