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Hemodynamic, Functional, and Clinical Responses to Pulmonary Artery Denervation in Patients With Pulmonary Arterial Hypertension of Different Causes Long-Term Outcomes of Patients With Mediastinal Radiation–Associated Coronary Artery Disease Undergoing Coronary Revascularization With Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients With Cancer Systematic Review and Network Meta‐Analysis Comparing Bifurcation Techniques for Percutaneous Coronary Intervention Implications of the local hemodynamic forces on the formation and destabilization of neoatherosclerotic lesions Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure Transseptal puncture versus patent foramen ovale or atrial septal defect access for left atrial appendage closure Evolving insights into the role of local shear stress in late stent failure from neoatherosclerosis formation and plaque destabilization 2015 ACC/HRS/SCAI Left Atrial Appendage Occlusion Device Societal Overview Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes
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Clinical Trial2018 Jan 25;82(2):369-375.

JOURNAL：Circ J. Article Link

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

Okai I, Dohi T, Okazaki S et al. Keywords: Calcified coronary lesion; Coronary artery disease; Percutaneous coronary intervention; Rotational atherectomy

ABSTRACT

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.

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