Clinical Characteristics and Long-Term Outcomes of Rotational Atherectomy　― J2T Multicenter Registry

• Published in: Circulation Journal Vol. 82; no. 2; pp. 369 - 375
• Main Authors: Okai, Iwao, Dohi, Tomotaka, Okazaki, Shinya, Jujo, Kentaro, Nakashima, Makoto, Otsuki, Hisao, Tanaka, Kazuki, Arashi, Hiroyuki, Okabe, Ryuta, Nagura, Fukuko, Nara, Yugo, Tamura, Hiroshi, Kurata, Takeshi, Kawashima, Hideyuki, Kyono, Hiroyuki, Yamaguchi, Junichi, Miyauchi, Katsumi, Kozuma, Ken, Hagiwara, Nobuhisa, Daida, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2018
• Subjects: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Atherectomy, Coronary - adverse effects; Atherectomy, Coronary - methods; Atherectomy, Coronary - mortality; Calcified coronary lesion; Coronary artery disease; Coronary Artery Disease - pathology; Coronary Artery Disease - therapy; Diabetes Mellitus; Humans; Japan - epidemiology; Longitudinal Studies; Middle Aged; Percutaneous Coronary Intervention; Registries; Retrospective Studies; Rotational atherectomy; Treatment Outcome; Vascular Calcification - therapy; Young Adult; Japan; Percutaneous coronary intervention; Rotational atherectomy; Calcified coronary lesion; Coronary artery disease
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-0668

Background:Rotational atherectomy (RA) is an adjunct tool for the management of heavily calcified coronary lesions during percutaneous coronary intervention (PCI), but the long-term clinical outcomes of RA use remain unclear in this drug-eluting stent era.Methods and Results:This multi-center registry assessed the characteristics and outcomes of patients treated by RA for calcified coronary lesions between 2004 and 2015. Among 1,090 registered patients, mean age was 70±10 years and 815 (75%) were male. Sixty percent of patients had diabetes mellitus and 27.7% were receiving hemodialysis. The procedure was successful in 96.2%. In-hospital death occurred in 33 patients (3.0%), and 14 patients (1.3%) developed definite/probable stent thrombosis. During the median follow-up period of 3.8 years, the incidence of major adverse cardiac events (MACE), defined as all-cause death, acute coronary syndrome, stent thrombosis, target vessel revascularization and stroke, was 46.7%. On multivariable Cox hazard analysis, hemodialysis (HR, 2.08; 95% CI: 1.53–2.86; P<0.0001) and age (HR, 1.03; 95% CI: 1.01–1.04; P<0.0001) were strong independent predictors of MACE. Conversely, statin treatment was associated with lower incidence of MACE (P=0.035).Conclusions:This study has provided the largest Japanese dataset for long-term follow-up of RA. Although RA in calcified lesions appears feasible with a high rate of procedural success, a high incidence of MACE was observed.