Comparison of rotational atherectomy, plain old balloon angioplasty, and cutting-balloon angioplasty prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions

BACKGROUND: The optimal technique for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation has not been described. The aim of this study was to compare the clinical outcomes of lesion preparation with rotational atherectomy (ROTA), plain old balloon angioplasty (POBA), or cutting-balloon angioplasty (CBA) in patients with HCCL who were treated with DES. METHODS: The study cohort comprised 737 consecutive patients (874 lesions) who underwent RA (n ≤ 264), POBA (n ≤ 220), or CBA (n ≤ 253) for HCCL at our institution and were treated with DES. Patients with mild or moderate calcified lesions, restenotic lesions, treatment with bare-metal stent (BMS), or history of prior coronary artery bypass graft (CABG) were excluded. The analyzed clinical parameters were the 1-month, 6-month, and 12-month rates of death (all-cause and cardiac), Q-wave myocardial infarction (MI), target-lesion revascularization (TLR), definite stent thrombosis (ST), and major adverse cardiac event (MACE), defined as the composite of death, Q-wave MI, or TLR. RESULTS: The patients were well matched for their baseline characteristics except for age (RA ≤ 71.9 ± 10.4 years; POBA ≤ 68.0 ± 10.8 years; CBA ≤ 68.7 ± 11.8 years; P<.001) and hypertension (RA ≤ 90.9%; POBA ≤ 80.9%; CBA ≤ 84.2%; P≤.01), which were different among the three cohorts. The three cohorts had similar clinical outcomes at both short-term and long-term follow-up. The 12-month results were all-cause death (RA ≤ 9.8%; POBA ≤ 8.2%; CBA ≤ 4.5%; P≤.18), cardiac death (RA ≤ 3.1%; POBA ≤ 2.5%; CBA ≤ 1.3%; P≤.61), Q-wave MI (RA ≤ 0%; POBA ≤ 0%; CBA ≤ 0.7%; P>.99), TLR (RA ≤ 5.2%; POBA ≤ 3.5%; CBA ≤ 3.9%; P≤.76), ST (RA ≤ 0%; POBA ≤ 0%; CBA ≤ 0.6%; P≤.63) and MACE (RA ≤ 14.6%; POBA ≤ 12.3%; CBA ≤ 8.3%; P≤.20). The 1-year MACE-free survival rates were also similar among the three cohorts (log-rank P≤.20). CONCLUSION: A strategy of lesion preparation with RA, POBA, or CBA in HCCL may be associated with similar clinical outcomes in patients undergoing percutaneous intervention with DES. The RA group had a trend toward greater MACE, death, and TLR.