{"title":"Clinical outcomes of rotational atherectomy followed by cutting balloon for calcified coronary lesions.","authors":"Tingquan Zhou, Xian Jin, Shixin Ma, Jiming Han, Chengxing Shen","doi":"10.1097/MCA.0000000000001515","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Rotational atherectomy is an effective method for treating severe coronary artery calcification; however, several challenges in its clinical application persist. This study aimed to compare the safety and effectiveness of rotational atherectomy combined with cutting balloon (RACB) versus rotational atherectomy with plain balloon (RAPB) in patients with heavily calcified coronary lesions.</p><p><strong>Methods: </strong>This retrospective observational cohort study included 326 patients who underwent rotational atherectomy at Shanghai Sixth People's Hospital from January 2016 to December 2022. Patients were divided into two groups (RACB and RAPB) on the basis of the type of balloon used. The primary outcome was the incidence of major adverse cardiovascular events (MACE) 1 year after percutaneous coronary intervention. Propensity score matching (PSM) was applied to minimize bias, and survival analyses were performed with the Cox proportional hazards model.</p><p><strong>Results: </strong>The procedural complication rates of the patients in the RACB and RAPB groups were comparable. Baseline covariates were balanced between groups after adjustment via PSM. Patients receiving RACB during their procedures had a lower MACE rate during the first postprocedural year in the unadjusted analysis (6.7% vs 16.2%, P < 0.05) and after adjustment with PSM (5.6% vs 16.1%, P < 0.01). The Kaplan-Meier survival curves revealed hazard ratios of 0.44 (95% CI: 0.23-0.82; P < 0.05) for the unadjusted model and 0.36 (95% CI: 0.17-0.76; P < 0.01) for the PSM-adjusted model.</p><p><strong>Conclusion: </strong>Performing RACB before stent implantation was demonstrated to be a safe and effective strategy for managing severely calcified coronary lesions.</p>","PeriodicalId":10702,"journal":{"name":"Coronary artery disease","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Coronary artery disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MCA.0000000000001515","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Rotational atherectomy is an effective method for treating severe coronary artery calcification; however, several challenges in its clinical application persist. This study aimed to compare the safety and effectiveness of rotational atherectomy combined with cutting balloon (RACB) versus rotational atherectomy with plain balloon (RAPB) in patients with heavily calcified coronary lesions.
Methods: This retrospective observational cohort study included 326 patients who underwent rotational atherectomy at Shanghai Sixth People's Hospital from January 2016 to December 2022. Patients were divided into two groups (RACB and RAPB) on the basis of the type of balloon used. The primary outcome was the incidence of major adverse cardiovascular events (MACE) 1 year after percutaneous coronary intervention. Propensity score matching (PSM) was applied to minimize bias, and survival analyses were performed with the Cox proportional hazards model.
Results: The procedural complication rates of the patients in the RACB and RAPB groups were comparable. Baseline covariates were balanced between groups after adjustment via PSM. Patients receiving RACB during their procedures had a lower MACE rate during the first postprocedural year in the unadjusted analysis (6.7% vs 16.2%, P < 0.05) and after adjustment with PSM (5.6% vs 16.1%, P < 0.01). The Kaplan-Meier survival curves revealed hazard ratios of 0.44 (95% CI: 0.23-0.82; P < 0.05) for the unadjusted model and 0.36 (95% CI: 0.17-0.76; P < 0.01) for the PSM-adjusted model.
Conclusion: Performing RACB before stent implantation was demonstrated to be a safe and effective strategy for managing severely calcified coronary lesions.
目的：旋转动脉粥样硬化切除术是治疗严重冠状动脉钙化的有效方法；然而，在其临床应用中仍然存在一些挑战。本研究旨在比较旋转动脉粥样硬化切除术联合切割球囊（RACB）与旋转动脉粥样硬化切除术联合普通球囊（RAPB）在严重钙化冠状动脉病变患者中的安全性和有效性。方法：本回顾性观察队列研究纳入了2016年1月至2022年12月在上海市第六人民医院行动脉粥样硬化旋转切除术的326例患者。根据使用球囊的类型将患者分为RACB组和RAPB组。主要结局是经皮冠状动脉介入治疗后1年的主要不良心血管事件（MACE）发生率。采用倾向评分匹配（PSM）最小化偏倚，并采用Cox比例风险模型进行生存分析。结果：RACB组和RAPB组患者的手术并发症发生率具有可比性。经PSM校正后各组间基线协变量平衡。在未经调整的分析中，术中接受RACB的患者在术后第一年的MACE率较低（6.7% vs 16.2%）。结论：在支架植入前进行RACB被证明是治疗严重钙化冠状动脉病变的一种安全有效的策略。
期刊介绍：
Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management.
Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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