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Ang SP, Krittanawong C, Usman MH, Iglesias J, Chia JE, Jahangirli K, Akinyemi T, Mukherjee D. Gender Differences in the Short and Long-Term Outcomes Following Rotational Atherectomy: A Meta-Analysis. Am J Cardiol 2024; 219:92-100. [PMID: 38492788 DOI: 10.1016/j.amjcard.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
Rotational atherectomy (RA) is used to address complex calcified coronary lesions but data regarding the association between gender and outcomes of patients who underwent RA remain uncertain. We aimed to investigate the short- and long-term outcomes of patients who underwent RA based on gender. A systematic literature search was performed in PubMed, Embase, and Cochrane databases from its inception until August 2023 for relevant studies. Endpoints were pooled using the DerSimonian and Laird random-effects model as odd ratios (OR) with 95% confidence intervals (CIs). A total of 7 studies with 8,490 patients (2,565 women and 5,925 men) who underwent RA were included in the study. In terms of periprocedural outcomes, women had a higher risk of in-hospital mortality (OR 2.00, 95% CI 1.08 to 3.68, p = 0.03), coronary dissection (OR 1.80, 95% CI 1.05 to 3.10, p = 0.03), coronary perforation (OR 1.96, 95% CI 1.19 to 3.23, p = 0.01), and stroke (OR 4.22, 95% CI 1.06 to 16.82, p = 0.04) than men. There were no significant differences between women and men in terms of major adverse cardiovascular events (OR 1.43, 95% CI 0.69 to 2.94, p = 0.33), myocardial infarction (OR 1.35, 95% CI 0.87 to 2.08, p = 0.18), bleeding (OR 1.71, 95% CI 0.88 to 3.30, p = 0.11), and cardiac tamponade (OR 2.30, 95% CI 0.45 to 11.68, p = 0.32). Over a follow-up period of 3 years, the results of meta-analysis showed that women had a higher risk of all-cause mortality (OR 1.45, 95% CI 1.19 to 1.77, p <0.001), long-term major adverse cardiovascular events (OR 1.38, 95% CI 1.10 to 1.74, p = 0.01), and long-term stroke (OR 3.41, 95% CI 1.63 to 7.17, p <0.001). The risk of long-term myocardial infarction was found to be similar between both genders (OR 1.45, 95% CI 0.95 to 2.22, p = 0.09). In conclusion, female gender is associated with adverse periprocedural and long-term outcome after RA. Women consistently demonstrated higher risk of in-hospital mortality, coronary dissection, coronary perforation, and stroke in the periprocedural period. Long-term follow-up further highlighted a heightened risk for women in terms of all-cause mortality and stroke.
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Affiliation(s)
- Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, New Jersey.
| | | | | | - Jose Iglesias
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, New Jersey; Department of Nephrology, Hackensack Meridian School of Medicine, Nutley, New Jersey; Department of Internal Medicine, Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Jia Ee Chia
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas
| | - Kanan Jahangirli
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, New Jersey
| | - Temitope Akinyemi
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, New Jersey
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, Texas; Department of Cardiology, Texas Tech University Health Science Center, El Paso, Texas
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Schwarz K, Mascherbauer J, Schmidt E, Zirkler M, Lamm G, Vock P, Kwok CS, Borovac JA, Mousavi RA, Hoppe UC, Leibundgut G, Will M. Emergency transvenous temporary pacing during rotational atherectomy. Front Cardiovasc Med 2023; 10:1322459. [PMID: 38162131 PMCID: PMC10755921 DOI: 10.3389/fcvm.2023.1322459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Rotational atherectomy (RA) during percutaneous coronary intervention may cause transient bradycardia or a higher-degree heart block. Traditionally, some operators use prophylactic transvenous pacing wire (TPW) to avoid haemodynamic complications associated with bradycardia. Objective We sought to establish the frequency of bail-out need for emergency TPW insertion in patients undergoing RA that have received no upfront TPW insertion. Methods We performed a single-centre retrospective study of all patients undergoing RA between October 2009 and October 2022. Patient characteristics, procedural variables, and in-hospital complications were registered. Results A total of 331 patients who underwent RA procedure were analysed. No patients underwent prophylactic TPW insertion. The mean age was 73.3 ± 9.1 years, 71.6% (n = 237) were male, while nearly half of the patients were diabetic [N = 158 (47.7%)]. The right coronary artery was the most common target for RA (40.8%), followed by the left anterior descending (34.1%), left circumflex (14.8%), and left main stem artery (10.3%). Altogether 20 (6%) patients required intraprocedural atropine therapy. Emergency TPW insertion was needed in one (0.3%) patient only. Eight (2.4%) patients died, although only one (0.3%) was adjudicated as being possibly related to RA-induced bradycardia. Five patients (1.5%) had ventricular fibrillation arrest, while nine (2.7%) required cardiopulmonary resuscitation. Six (1.8%) procedures were complicated by coronary perforation, two (0.6%) were complicated by tamponade, while 17 (5.1%) patients experienced vascular access complications. Conclusions Bail-out transvenous temporary pacing is very rarely required during RA. A standby temporary pacing strategy seems reasonable and may avoid unnecessary TPW complications compared with routine use.
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Affiliation(s)
- Konstantin Schwarz
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Julia Mascherbauer
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Elisabeth Schmidt
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Martina Zirkler
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Gudrun Lamm
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Paul Vock
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Chun Shing Kwok
- Department of Cardiology, University North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Josip Andelo Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split (KBC Split), Split, Croatia
| | - Roya Anahita Mousavi
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
| | - Uta C. Hoppe
- University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Leibundgut
- Klinik für Kardiologie, Universitätsspital Basel, Basel, Switzerland
| | - Maximilian Will
- Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St. Pölten, Austria
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Joodi G, Palimar S, Press MC. Percutaneous Coronary Interventions in Women. Curr Atheroscler Rep 2023; 25:829-837. [PMID: 37815649 PMCID: PMC10618306 DOI: 10.1007/s11883-023-01150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
PURPOSEOF REVIEW Cardiovascular disease is the leading cause of morbidity and mortality among women globally. Numerous studies show ongoing disparities in diagnosis, management, and outcomes of ischemic heart disease in women compared to men. We aim to review the factors contributing to sex-based differential outcomes of percutaneous coronary interventions in women. RECENT FINDINGS Hormonal influence on coronary arteries and progression of atherosclerosis in women results in distinct coronary plaque characteristics and unique pathological process such as spontaneous coronary artery dissection and myocardial infarction with non-obstructive coronary arteries. During the presentation of acute coronary syndromes, women are older and have higher burden of comorbidities, with higher short- and long-term mortality. Awareness of differences in vascular biology and unique risk factors for cardiovascular disease in women is essential for sustained improvement in cardiovascular mortality. Better representation of women in trials is crucial to address the gaps in knowledge and allow for individualized treatment approaches in women.
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Affiliation(s)
- Golsa Joodi
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sristi Palimar
- Institute for Society and Genetics, UCLA, Los Angeles, CA, USA
| | - Marcella Calfon Press
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Ayoub M, Lutsch S, Behnes M, Akin M, Schupp T, Akin I, Rudolph V, Westermann D, Mashayekhi K. Sex-Based Differences in Rotational Atherectomy and Long-Term Clinical Outcomes. J Clin Med 2023; 12:5044. [PMID: 37568447 PMCID: PMC10419943 DOI: 10.3390/jcm12155044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Present research on the influence of gender on the treatment of coronary artery disease (CAD) and the outcome after percutaneous coronary intervention (PCI) is inconsistent. Sex differences in the presentation of CAD and the success after treatment have been described. We intend to compare the male and female sex in the procedure and the long-term outcome of Rotational Atherectomy (RA). A total of 597 consecutive patients (20.3% female and 79.7% male, mean age 75.3 ± 8.9 years vs. 72.7 ± 9 years, p < 0.001) undergoing Rotational Atherectomy between 2015 and 2020 were enrolled in the analysis. Demographic and clinical data were registered. In-hospital, 1-year, and 3-year MACCEs (major adverse cardiac and cerebrovascular events) were calculated. Women presented more often with myocardial infarction (23.9% vs. 14.9%, p = 0.017). The intervention was mainly performed via femoral access compared to radial access (65.4% vs. 33.6%, p = 0.002). Women had a smaller diameter of the balloon predilatation compared to men (2.8 ± 0.5 mm vs. 3.15 ± 2.4 mm, p < 0.05) and a smaller maximum diameter of the implanted stent (3.5 ± 1.2 mm vs. 4.10 ± 6.5 mm, p = 0.01). In-hospital, 1-year-, and 3-year MACCEs did not differ between the sexes. After a multivariate analysis, no difference between men and women could be detected. In conclusion, this analysis shows differences between women and men in periprocedural characteristics but does not show any differences after RA regarding in-hospital, 1-year-, and 3-year MACCEs.
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Affiliation(s)
- Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany; (S.L.)
| | - Selina Lutsch
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany; (S.L.)
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Volker Rudolph
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany; (S.L.)
| | - Dirk Westermann
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, 79189 Bad Krozingen, Germany
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
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5
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Sambola A, García Del Blanco B, Kunadian V, Vogel B, Chieffo A, Vidal M, Ratcovich H, Botti G, Wilkinson C, Mehran R. Sex-based Differences in Percutaneous Coronary Intervention Outcomes in Patients With Ischemic Heart Disease. Eur Cardiol 2023. [DOI: 10.15420/ecr.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
In high-income countries, ischaemic heart disease is the leading cause of death in women and men, accounting for more than 20% of deaths in both sexes. However, women are less likely to receive guideline-recommended percutaneous coronary intervention (PCI) than men. Women undergoing PCI have poorer unadjusted outcomes because they are older and have greater comorbidity than men, but uncertainty remains whether sex affects outcome after these differences in clinical characteristics are considered. In this paper, we review recent published evidence comparing outcomes between men and women undergoing PCI. We focus on the sex differences in PCI outcomes in different scenarios: acute coronary syndromes, stable angina and complex lesions, including the approach of left main coronary artery. We also review how gender is considered in recent guidelines and offer a common clinical scenario to illustrate the contemporary management strategies an interventional cardiologist should consider when performing PCI on a female patient.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Bellaterra, Spain
| | - Bruno García Del Blanco
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Bellaterra, Spain
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Alaide Chieffo
- nterventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - María Vidal
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma, Bellaterra, Spain
| | - Hanna Ratcovich
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Giulia Botti
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Chris Wilkinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, US
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6
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Fitzgerald S, Gimenez MR, Allali A, Toelg R, Sulimov DS, Geist V, Kastrati A, Thiele H, Richardt G, Abdel-Wahab M. Sex-specific Inequalities in the Treatment of Severely Calcified Coronary Lesions: A Sub-analysis of the PREPARE-CALC Trial. Interv Cardiol 2023; 18:e02. [PMID: 36891034 PMCID: PMC9987508 DOI: 10.15420/icr.2022.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/09/2022] [Indexed: 01/21/2023] Open
Abstract
Background: Coronary vessels in women may have anatomical and histological particularities. The aim of this study was to investigate sex-specific characteristics and outcomes of patients with calcified coronary arteries in the Prepare-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial. Methods: The Prepare-CALC trial randomised patients with severe coronary calcification to coronary lesion preparation either using modified balloons (MB; cutting or scoring) or rotational atherectomy (RA). Results: Of 200 randomised patients, 24% were women. Strategy success in general was similar between women (93.8%) and men (88.2%; p=0.27). For men, strategy success was significantly more common with an RA-based strategy than an MB-based strategy (98.7% in the RA group versus 77.3% in the MB group, p<0.001), whereas for women there was no evidence of a significant difference in strategy success between RA and MB (95.7% in the RA group versus 92% in the MB group, p>0.99, p for interaction between sex and treatment strategy=0.03). Overall, significant complications such as death, MI, stent thrombosis, bypass operation and perforations were rare and did not differ significantly by gender or treatment strategy. Plaque rupture and disrupted calcified nodules were more common in women. Conclusion: In a well-defined patient population with severely calcified coronary arteries, lesion preparation with an RA-strategy was superior to an MB-strategy in men. For women, both RA and MB strategies appear to have a similar success rate, although definitive conclusions are limited due to the small number of women in the trial.
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Affiliation(s)
- Sean Fitzgerald
- Heart Center Leipzig Leipzig, Germany.,School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences Dublin, Ireland
| | | | | | - Ralph Toelg
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
| | | | - Volker Geist
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technical University of Munich Germany
| | | | - Gert Richardt
- Heart Center, Segeberger Kliniken Bad Segeberg, Germany
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Impact of Sex on Clinical Outcomes in Patients undergoing Complex Percutaneous Coronary Angioplasty (from the e-ULTIMASTER Study). Am J Cardiol 2023; 186:71-79. [PMID: 36368145 DOI: 10.1016/j.amjcard.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
Female gender has been shown to be associated with worse clinical outcomes after percutaneous coronary intervention (PCI). However, the impact of gender on the clinical outcomes of complex PCI is still poorly understood. This study examined the differences in patient and coronary lesion characteristics and longer-term clinical outcomes in male and female patients who underwent complex PCI. This was a sub-analysis of the e-ULTIMASTER study, which was a large, multicontinental, prospective, observational study enrolling 37,198 patients who underwent PCI with the Ultimaster stent. Patients who underwent complex PCI were stratified by gender. The primary outcome was target lesion failure at 12 months, defined as the composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization at 12 months. A total of 13,623 patients underwent complex procedures, of which 35.7% were women. Women were twice as likely as men to be aged ≥80 years (17.6% vs 9%, p <0.0001) and had a higher prevalence of cardiovascular risk factors. Women had fewer lesions treated than men (1.5 ± 0.8 vs 1.6 ± 0.8, p <0.0001) and fewer stents implanted (2.0 ± 1.1 vs 2.1 ± 1.1, p <0.0001). There was no statistically significant difference in clinical outcomes at 12 months between women and men. Event rates were comparable in women and men for target lesion failure (4.7% vs 4.3%, p = 0.30), target vessel failure (5.1% vs 4.9%, p = 0.73), and cardiac death (1.8% vs 1.7%, p = 0.80).In conclusion, our findings suggest no significant differences in clinical outcomes between women and men who underwent complex PCI.
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Mikhail P, Howden N, Monjur M, Jeyaprakash P, Said C, Bland A, Collison D, McCartney P, Adamson C, Morrow A, Carrick D, McEntegart M, Ford TJ. Coronary perforation incidence, outcomes and temporal trends (COPIT): a systematic review and meta-analysis. Open Heart 2022; 9:openhrt-2022-002076. [PMID: 36270713 PMCID: PMC9594565 DOI: 10.1136/openhrt-2022-002076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary perforation is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We studied incidence, outcomes and temporal trends following PCI-related coronary artery perforation (CAP). METHODS Prospective systematic review and meta-analysis including meta-regression using MEDLINE and EMBASE to November 2020. We included 'all-comer' PCI cohorts including large PCI registries and randomised controlled trials and excluding registries or trials limited to PCI in high-risk populations such as chronic total occlusion PCI or cohorts treated only with atheroablative devices. Regression analysis and corresponding correlation coefficients were performed comparing perforation incidence, mortality rate, tamponade rate and the rate of Ellis III perforations against the midpoint (year) of data collection to determine if a significant temporal relationship was present. RESULTS 3997 studies were screened for inclusion. 67 studies met eligibility criteria with a total of 5 568 191 PCIs included over a 38-year period (1982-2020). The overall pooled incidence of perforation was 0.39% (95% CI 0.34% to 0.45%) and remained similar throughout the study period. Around 1 in 5 coronary perforations led to tamponade (21.1%). Ellis III perforations are increasing in frequency and account for 43% of all perforations. Perforation mortality has trended lower over the years (7.5%; 95% CI 6.7% to 8.4%). Perforation risk factors derived using meta-regression were female sex, hypertension, chronic kidney disease and previous coronary bypass grafting. Coronary perforation was most frequently caused by distal wire exit (37%) followed by balloon dilation catheters (28%). Covered stents were used to treat 25% of perforations, with emergency cardiac surgery needed in 17%. CONCLUSION Coronary perforation complicates approximately 1 in 250 PCIs. Ellis III perforations are increasing in incidence although it is unclear whether this is due to reporting bias. Despite this, the overall perforation mortality rate (7.5%) has trended lower in recent years. Limitations of our findings include bias that may be introduced through analysis of multidesign studies and registries without pre-specified standardised perforation reporting CMore research into coronary perforation management including the optimal use of covered stents seems warranted. PROSPERO REGISTRATION NUMBER CRD42020207881.
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Affiliation(s)
- Philopatir Mikhail
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicklas Howden
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Mohammad Monjur
- Department of Cardiology, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Prajith Jeyaprakash
- Department of Cardiology, Nepean Hospital, Penrith, New South Wales, Australia
| | - Christian Said
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Adam Bland
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Damien Collison
- Department of Cardiology, Golden Jubilee Hospital, Clydebank, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter McCartney
- Department of Cardiology, Golden Jubilee Hospital, Clydebank, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Carly Adamson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Morrow
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David Carrick
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,Department of Cardiology, University Hospital Hairmyres, East Kilbride, UK
| | | | - Thomas J Ford
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia,Faculty of Medicine, The University of Newcastle, Newcastle, NSW, Australia,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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9
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Sex difference in clinical and procedural outcomes in patients undergoing coronary atherectomy: a systematic review and meta-analysis. Coron Artery Dis 2022; 33:634-642. [PMID: 36238981 DOI: 10.1097/mca.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. METHODS PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel random-effects model. RESULTS Six observational studies with 3517 patients (2420 men and 1035 women) were included in this meta-analysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37-3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11-1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06-14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23-3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30-3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. CONCLUSION In our analysis, women undergoing CA are at increased risk of mid-term mortality and procedure-related complications including stroke, coronary dissection, and major bleeding.
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Ford TJ, Adamson C, Morrow AJ, Rocchiccioli P, Collison D, McCartney PJ, Shaukat A, Lindsay M, Good R, Watkins S, Eteiba H, Robertson K, Berry C, Oldroyd KG, McEntegart M. Coronary Artery Perforations: Glasgow Natural History Study of Covered Stent Coronary Interventions (GNOCCI) Study. J Am Heart Assoc 2022; 11:e024492. [PMID: 36129052 DOI: 10.1161/jaha.121.024492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary Interventions) Study was to report the incidence and outcomes of coronary artery perforations over an 18-year period at a single, high-volume percutaneous coronary intervention center. We considered both the temporal trends and long-term outcomes of covered stent deployment. Methods and Results We evaluated procedural and long-term clinical outcomes following coronary perforation in a cohort of 43,343 consecutive percutaneous coronary intervention procedures. Procedural major adverse cardiac events were defined as a composite of death, myocardial infarction, stroke, target vessel revascularization, or cardiac surgery within 24 hours. A total of 161 (0.37%) procedures were complicated by coronary perforation of which 57 (35%) were Ellis grade III. Incidence increased with time over the study period (r=0.73; P<0.001). Perforation severity was linearly associated with procedural mortality (median 2.9-year follow-up): Ellis I (0%), Ellis II (1.7%), Ellis III/IIIB (21%), P<0.001. Procedural major adverse cardiac events occurred in 47% of patients with Ellis III/IIIB versus 13.5% of those with Ellis I/II perforations (odds ratio, 5.8; 95% CI, 2.7-12.5; P<0.001). Covered stents were associated with an increased risk of stent thrombosis at 2.9-year follow-up (Academic Research Consortium definite or probable; 9.1% versus 0.9%; risk ratio, 10.5; 95% CI, 1.1-97; P=0.04). Conclusions The incidence of coronary perforation increased between 2001 and 2019. Severe perforation was associated with higher procedural major adverse cardiac events and was an independent predictor of long-term mortality. Although covered stents are a potentially lifesaving treatment, the generation of devices used during the study period was limited by their efficacy and high risk of stent thrombosis. Registration Information Clinicaltrials.gov. Identifier: NCT03862352.
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Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
- Faculty of Medicine University of Newcastle Callaghan NSW Australia
| | - Carly Adamson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Andrew J Morrow
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Damien Collison
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Peter J McCartney
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Richard Good
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre Golden Jubilee National Hospital Clydebank UK
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow Glasgow UK
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11
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Calcagno S, Romagnoli E, Versaci F. Calcified lesion treatment: spend more to save more? Minerva Cardiol Angiol 2022; 70:329-331. [PMID: 35332748 DOI: 10.23736/s2724-5683.22.06007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Simone Calcagno
- Division of Cardiology, San Paolo Hospital, Civitavecchia, Roma, Italy
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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12
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Rishad S, McENTEGART M, Ford TJ, DI-Mario C, Fajadet J, Lindsay M, Watkins S, Eteiba H, Brogan R, Good R, Oldroyd KG. Comparative study of costs and resource utilisation of rotational atherectomy versus intravascular lithotripsy for percutaneous coronary intervention. Minerva Cardiol Angiol 2021; 70:332-340. [PMID: 34761665 DOI: 10.23736/s2724-5683.21.05681-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a novel alternative to rotational atherectomy (RA) for the modification of heavily calcified coronary stenoses prior to percutaneous coronary intervention (PCI). We compare the real-world resource utilisation and associated costs of PCI with adjunctive RA and IVL. METHODS We compared the resource utilisation, in-lab consumable costs and procedural data of 120 patients who underwent PCI with IVL from the Disrupt-CAD II study (NCT03328949) to 60 patients who underwent PCI with RA at the Golden Jubilee National Hospital, Glasgow. The RA patients were consecutive and selected on the basis of being deemed suitable for IVL by an independent interventional cardiologist experienced in the use of both techniques. RESULTS PCI with IVL was associated with significantly lower costs than PCI with RA (mean difference £398 [95% CI, £181-£615]; p<0.001). Considering between-group differences, the IVL group used 4.02 fewer balloons (p<0.001), 3.03 fewer guidewires (p<0.001), 0.52 fewer guide catheters (p=0.001), 0.22 fewer guide extensions (p=0.004) and 1.03 fewer drug eluting stents (DES) (p<0.001) per case than the RA group. The IVL group had shorter procedural duration (mean difference 13.3 min [95% CI, 3.6-23.0]; p=0.008) but longer fluoroscopy times (mean difference 4.4 min [95% CI, 1.7-7.1]; p=0.002). CONCLUSIONS In this indirect comparison, we found that the higher initial device costs of IVL may be offset by a lower overall resource utilisation. Further research is required to confirm this, and future randomised trials should include a formal health economic analysis.
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Affiliation(s)
- Shafeer Rishad
- University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Margaret McENTEGART
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK.,Faculty of Medicine, University of Newcastle NSW, Newcastle, Australia
| | - Carlo DI-Mario
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Richard Brogan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Keith G Oldroyd
- University of Glasgow, Glasgow, UK - .,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
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13
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Bouisset F, Ribichini F, Bataille V, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, Zajdel W, Faurie B, Mezilis N, Palazuelos J, Spedicato L, Valdés M, Vaquerizo B, Ferenc M, Cayla G, Barbato E, Carrié D. Effect of Sex on Outcomes of Coronary Rotational Atherectomy Percutaneous Coronary Intervention (From the European Multicenter Euro4C Registry). Am J Cardiol 2021; 143:29-36. [PMID: 33359202 DOI: 10.1016/j.amjcard.2020.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Data regarding the potential influence of gender on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of gender on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. In them, 267 (27.6%) were females. Female patients were older than males (77.7 years old ± 9.8 vs 73.3 ± 9.5 years old respectively, p < 0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p < 0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p = 0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p = 0.004). In-hospital major adverse cardiac event rate-defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization, and coronary artery bypass grafting surgery-was higher in the female group (7.1% vs 3.7%, p = 0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ in gender, neither did cardiovascular medications at discharge. At 1 year follow-up, rate of major adverse cardiac event was 18.4% in the female group vs 11.2% in the male group (adjusted Hazard Ratio 1.82 [1.24 to 2.67], p = 0.002). No significant bleeding differences were observed in gender, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at 1 year follow-up than did men.
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14
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Otsuki H, Jujo K, Tanaka K, Okai I, Nakashima M, Dohi T, Okazaki S, Okabe R, Nagura F, Nara Y, Kawashima H, Kyono H, Arashi H, Yamaguchi J, Tamura H, Kurata T, Miyauchi K, Kozuma K, Daida H, Hagiwara N. Sex differences in clinical outcomes after rotational atherectomy of calcified coronary stenoses: from multicenter registry. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:12-20. [PMID: 33815915 PMCID: PMC8012285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Recent improvements in devices and medications may diminish the risk of adverse events following percutaneous coronary intervention (PCI) in women. However, complex calcified coronary lesions are increasingly being encountered in clinical practice, which remain challenging for contemporary PCI. Rotational atherectomy (RA) of severely calcified lesions is an option that facilitates the technical success of PCI. We aimed to examine sex differences in long-term clinical prognoses after PCI with RA in the drug-eluting stent (DES) era. METHODS AND RESULTS We evaluated J2T ROTA registry data from 1,090 patients with severely calcified de novo coronary artery stenoses who underwent PCI using RA at 3 hospitals between 2004 and 2015. After excluding patients who received regular hemodialysis, 788 patients, including 570 men and 218 women, were ultimately analyzed. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), which included death, acute coronary syndrome (ACS), and stroke. The women were significantly older, and presented more frequently with chronic kidney disease, ACS, atrial fibrillation, lower body mass indexes, and worse lipid profiles than the men. During the observation period, MACCE occurred in 197 patients (25%) (118 deaths, 29 strokes, and 50 ACS). In the unmatched population, women had a higher MACCE rate than men (hazard ratio: 1.48, [95% confidence interval: 1.07-2.06]). However, sex was not associated with MACCE in the propensity score-matched population. CONCLUSION In the DES era, differences between sexes were not observed in relation to long-term MACCE in patients undergoing PCI with RA for severely calcified coronary artery stenoses.
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Affiliation(s)
- Hisao Otsuki
- Department of Cardiology, Tokyo Women’s Medical UniversityJapan
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women’s Medical UniversityJapan
| | - Kazuki Tanaka
- Department of Cardiology, Tokyo Women’s Medical UniversityJapan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University School of MedicineJapan
| | - Makoto Nakashima
- Department of Cardiology, Teikyo University School of MedicineJapan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University School of MedicineJapan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University School of MedicineJapan
| | - Ryuta Okabe
- Department of Cardiology, Teikyo University School of MedicineJapan
| | - Fukuko Nagura
- Department of Cardiology, Teikyo University School of MedicineJapan
| | - Yugo Nara
- Department of Cardiology, Teikyo University School of MedicineJapan
| | | | - Hiroyuki Kyono
- Department of Cardiology, Teikyo University School of MedicineJapan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women’s Medical UniversityJapan
| | | | - Hiroshi Tamura
- Department of Cardiovascular Medicine, Juntendo University School of MedicineJapan
| | - Takeshi Kurata
- Department of Cardiovascular Medicine, Juntendo University School of MedicineJapan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of MedicineJapan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University School of MedicineJapan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of MedicineJapan
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15
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Erben Y, Bews KA, Hanson KT, Da Rocha-Franco JA, Money SR, Stone W, Farres H, Meltzer AJ, Gloviczki P, Oderich GS, Hakaim AG, Habermann EB. Female Sex is a Marker for Higher Morbidity and Mortality after Elective Endovascular Aortic Aneurysm Repair: A National Surgical Quality Improvement Program Analysis. Ann Vasc Surg 2020; 69:1-8. [DOI: 10.1016/j.avsg.2020.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 01/27/2023]
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16
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Bouisset F, Barbato E, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, Cayla G, Lhermusier T, Zajdel W, Palazuelos Molinero J, Ferenc M, Ribichini FL, Carrié D. Clinical outcomes of PCI with rotational atherectomy: the European multicentre Euro4C registry. EUROINTERVENTION 2020; 16:e305-e312. [DOI: 10.4244/eij-d-19-01129] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Moroni F, Arrivi A, Pucci G, Azzalini L. Rotational atherectomy: once again on stage. Minerva Cardioangiol 2020; 68:123-125. [DOI: 10.23736/s0026-4725.20.05240-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Persampieri S, Lucreziotti S, Salerno-Uriarte D, Barbieri L, Sponzilli C, Valli F, Centola M, Castini D, Carugo S. Predictors of procedural and clinical outcome in rotational atherectomy: analysis of a single center registry. Minerva Cardioangiol 2020; 68:126-133. [PMID: 32100983 DOI: 10.23736/s0026-4725.20.05096-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Heavy calcified lesions can decrease effectiveness of drug eluted stents in preventing restenosis. Rotational atherectomy (RA) demonstrated to improve outcomes in patients with severely calcified lesions pretreated with debulking. However, its feasibility and its safety are continuously on stage. Our aim has been to identify predictors of clinical and procedural outcome in RA. METHODS We retrospectively analyzed a population of patients referred to our cath lab for urgent or elective coronary catheterization treated with RA. The associations between clinical variables and clinical or procedural events were evaluated using logistic regression. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) from procedure date to last day of follow-up. MACE have been defined as follows: cardiovascular death, heart failure hospitalization and target lesion revascularization. RESULTS The registry included 68 of the 1908 (3.6%) patients that underwent percutaneous coronary intervention. Procedural success was as high as 94% and more than 90% of cases were treated without any complication. The most common complication during PCI with RA was vessel dissection (8.8%) and no procedural death occurred. None of the clinical nor procedural characteristics were associated with burr entrapment or vascular access hematoma. We identified as independent predictor of treated vessel dissection the female sex (OR 16.9, 95% CI 1.55-183.77, P<0.05). Logistic regression revealed age (OR 1.17, 95% CI: 1.02-1.33, P<0.02) as the only independent predictor of MACE. We therefore calculated the ROC curve on age in predicting MACE, that showed a C-statistics of 0.75 (95% CI 0.628 to 0.852, P=0.02), with 80 years old as the best threshold in defining high risk population. CONCLUSIONS RA is a feasible and safe procedure. Females and elderly patients must be carefully selected in order to balance the risk/benefit ratio in these high-risk populations.
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Affiliation(s)
- Simone Persampieri
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy -
| | - Stefano Lucreziotti
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
| | - Diego Salerno-Uriarte
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
| | - Lucia Barbieri
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
| | - Carlo Sponzilli
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
| | - Federica Valli
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
| | - Marco Centola
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
| | - Diego Castini
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
| | - Stefano Carugo
- Operative Unit of Cardiology and Cardiological Intensive Therapy, San Paolo Hospital, Milan, Italy
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19
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Ford TJ, Khan A, Docherty KF, Jackson A, Morrow A, Sidik N, Rocchiccioli P, Good R, Eteiba H, Watkins S, Shaukat A, Lindsay M, Robertson K, Petrie M, Berry C, Oldroyd KG, McEntegart M. Sex differences in procedural and clinical outcomes following rotational atherectomy. Catheter Cardiovasc Interv 2020; 95:232-241. [PMID: 31264314 PMCID: PMC7027486 DOI: 10.1002/ccd.28373] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/16/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022]
Abstract
AIM Evaluate sex differences in procedural net adverse clinical events and long-term outcomes following rotational atherectomy (RA). METHODS AND RESULTS From August 2010 to 2016, 765 consecutive patients undergoing RA PCI were followed up for a median of 4.7 years. 285 (37%) of subjects were female. Women were older (mean 76 years vs. 72 years; p < .001) and had more urgent procedures (64.6 vs. 47.3%; p < .001). Females received fewer radial procedures (75.1 vs. 85.1%; p < .001) and less intravascular imaging guidance (16.8 vs. 25.0%; p = .008). After propensity score adjustment, the primary endpoint of net adverse cardiac events (net adverse clinical events: all-cause death, myocardial infarction, stroke, target vessel revascularization plus any procedural complication) occurred more often in female patients (15.1 vs. 9.0%; adjusted OR 1.81 95% CI 1.04-3.13; p = .037). This was driven by an increased risk of procedural complications rather than procedural major adverse cardiac events (MACE). Specifically, women were more likely to experience coronary dissection (4.6 vs. 1.3%; p = .008), cardiac tamponade (2.1 vs. 0.4%; p = .046) and significant bleeding (BARC ≥2: 5.3 vs. 2.3). Despite this, overall MACE-free survival was similar between males and females (adjusted HR 1.03; 95% CI 0.80-1.34; p = .81). Procedural complications during RA were associated with almost double the incidence of MACE at long-term follow-up (HR 1.92; 95% CI 1.34-2.77; p < .001). CONCLUSION Women may be at greater risk of procedural complications following rotational atherectomy. These include periprocedural bleeding episodes and coronary perforation leading to cardiac tamponade. Despite this, the adjusted overall long-term survival free of major adverse cardiac events was similar between males and females.
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Affiliation(s)
- Thomas J. Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
- Gosford HospitalNSWAustralia
| | - Adnan Khan
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Kieran F. Docherty
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Alice Jackson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Andrew Morrow
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Novalia Sidik
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Paul Rocchiccioli
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Richard Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Aadil Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Keith Robertson
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
| | - Mark Petrie
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Keith G. Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowScotland
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