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Another Nail in the Coffin for Intra-Aortic Balloon Counterpulsion in Acute Myocardial Infarction With Cardiogenic Shock Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry Genetic dysregulation of endothelin-1 is implicated in coronary microvascular dysfunction Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study A Test in Context: E/A and E/e' to Assess Diastolic Dysfunction and LV Filling Pressure Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity Invasive Versus Medical Management in Patients With Prior Coronary Artery Bypass Surgery With a Non-ST Segment Elevation Acute Coronary Syndrome: A Pilot Randomized Controlled Trial

Original Research2018 Mar 23;82(4):983-991.

JOURNAL:Circ J. Article Link

Five-Year Clinical Outcomes After Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Lesions

Jinnouchi H, Kuramitsu S, Shinozaki T et al. Keywords: Calcification; Drug-eluting stent; Percutaneous coronary intervention; Rotational atherectomy

ABSTRACT


BACKGROUND - Percutaneous coronary intervention for heavily calcified lesions requires rotational atherectomy (RA). Long-term clinical outcomes after drug-eluting stent (DES) implantation following (RA) for heavily calcified lesions remain unclear. We assessed 5-year clinical outcomes after DES implantation following RA.


METHODS AND RESULTS- Between March 2006 and September 2011, 219 consecutive patients with 219 lesions treated with DES following RA, were retrospectively enrolled. The cumulative 5-year incidence of target-lesion revascularization (TLR) and definite stent thrombosis (ST) were assessed. The cumulative incidence of TLR within (≤) the first year was 18.6%. Late TLR beyond (>) 1 year continued to occur at 1.9% per year without a decrease in the rate (5-year incidence, 26.0%). The cumulative incidence of definite ST at 30 days, 1 and 5 years was 0.9%, 2.3% and 2.9%, respectively. The annual rate of definite ST beyond 1 year was 0.15%. On multivariate analysis, the significant predictor of TLR within 1 year was use of first-generation DES (hazard ratio [HR], 2.09; 95% CI: 1.10-4.03, P=0.02) and that of TLR beyond 1 year was hemodialysis (HR, 3.29; 95% CI: 1.06-10.55, P=0.04).


CONCLUSIONS - Late TLR beyond 1 year continued to occur up to 5 years at a constant annual incidence, whereas very late ST was rare. Careful long-term clinical follow-up is continually needed in patients who have already received DES following RA for heavily calcified lesions.