TY - JOUR
T1 - Rotational Atherectomy for Severely Calcified Lesions in Patients With Left Ventricular Systolic Dysfunction
T2 - One-Year Outcomes From aSingle-Center Registry Analysis
AU - Yoshida, Ruka
AU - Ishii, Hideki
AU - Morishima, Itsuro
AU - Tanaka, Akihito
AU - Takagi, Kensuke
AU - Yoshioka, Naoki
AU - Morita, Yasuhiro
AU - Unno, Kazumasa
AU - Yoshida, Yukihiko
AU - Tsuboi, Hideyuki
AU - Murohara, Toyoaki
N1 - Funding Information:
The authors thank Mr. Kazunori Shibata for his assistance with imaging data collection. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Department of Cardiology, Nagoya University Graduate School of Medicine received research grant from Astellas Pharma Inc. Daiichi-Sankyo Co. Ltd. Dainippon Sumitomo Pharma Co. Ltd. Kowa Co. Ltd. MSD K. K. Mitsubishi Tanabe Pharma Co. Nippon Boehringer Ingelheim Co. Ltd. Pfizer Japan Inc. and Teijin Pharma Ltd. H. Ishii. received lecture fees from Astellas Pharma Inc. Bayer Pharmaceutical Co. Ltd. Daiichi-Sankyo Pharma Inc. and MSD K. K. T. Murohara received lecture fees from Bayer Yakuhin. Ltd. Daiichi-Sankyo Co. Ltd. MSD K. K. Mitsubishi Tanabe Pharma Co. Nippon Boehringer Ingelheim Co. Ltd.
Funding Information:
Department of Cardiology, Nagoya University Graduate School of Medicine received research grant from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - Background: High-risk percutaneous coronary intervention (PCI) in patients with left ventricular (LV) systolic dysfunction has been proven to induce reverse LV remodeling. However, the impact of high-risk PCI focusing on rotational atherectomy (RA) in patients with severe LV systolic dysfunction has not been completely addressed. Methods: Among 4339 consecutive patients who underwent PCI, 178 patients with 192 lesions were treated with RA. The reduced ejection fraction (EF) group (LVEF ≤35%) included 25 patients, the mid-range EF group (LVEF 36–50%) included 44 patients, and the preserved EF group (LVEF >50%) included 109 patients. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke. Results: The cumulative 1-year incidence of the primary outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). After adjusting for confounding factors, the incidence of the primary outcome in the reduced EF group (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.43–2.37; p = 0.87) and the mid-range EF group (HR, 0.99; 95% CI, 0.47–1.94; p = 0.97) was similar to that in the preserved EF group. LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and −0.7 ± 7.8%, respectively; p < 0.0001). Conclusions: Reduced EF was not associated with increase in the primary outcome in patients undergoing RA. This seemed to result from the improved LV function after PCI. Summary for annotated table of contents: This single center analysis study investigated 1-year composite outcome of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke in patients with severe LV systolic dysfunction undergoing RA compared with that in patients with preserved LV function. The cumulative 1-year incidence of the composite outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and −0.7 ± 7.8%, respectively; p < 0.0001).
AB - Background: High-risk percutaneous coronary intervention (PCI) in patients with left ventricular (LV) systolic dysfunction has been proven to induce reverse LV remodeling. However, the impact of high-risk PCI focusing on rotational atherectomy (RA) in patients with severe LV systolic dysfunction has not been completely addressed. Methods: Among 4339 consecutive patients who underwent PCI, 178 patients with 192 lesions were treated with RA. The reduced ejection fraction (EF) group (LVEF ≤35%) included 25 patients, the mid-range EF group (LVEF 36–50%) included 44 patients, and the preserved EF group (LVEF >50%) included 109 patients. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke. Results: The cumulative 1-year incidence of the primary outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). After adjusting for confounding factors, the incidence of the primary outcome in the reduced EF group (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.43–2.37; p = 0.87) and the mid-range EF group (HR, 0.99; 95% CI, 0.47–1.94; p = 0.97) was similar to that in the preserved EF group. LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and −0.7 ± 7.8%, respectively; p < 0.0001). Conclusions: Reduced EF was not associated with increase in the primary outcome in patients undergoing RA. This seemed to result from the improved LV function after PCI. Summary for annotated table of contents: This single center analysis study investigated 1-year composite outcome of cardiac death, non-fatal myocardial infarction, target-vessel revascularization, and ischemic stroke in patients with severe LV systolic dysfunction undergoing RA compared with that in patients with preserved LV function. The cumulative 1-year incidence of the composite outcome was similar among the three groups (reduced EF, 29%; mid-range EF, 25%; preserved EF, 26%; p = 0.95). LVEF was significantly improved in the reduced EF and mid-range EF groups compared with the preserved EF group (absolute change in LVEF: 13.6 ± 11.3%, 9.0 ± 10.1%, and −0.7 ± 7.8%, respectively; p < 0.0001).
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U2 - 10.1016/j.carrev.2020.03.033
DO - 10.1016/j.carrev.2020.03.033
M3 - Article
C2 - 32457019
AN - SCOPUS:85085217965
VL - 21
SP - 1220
EP - 1227
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
SN - 1553-8389
IS - 10
ER -