Skip to main content
Have a personal or library account? Click to login
Clinical Outcomes of Rotational Atherectomy in Heavily Calcified Lesions: Evidence From the Largest Cardiac Center in Thailand Cover

Clinical Outcomes of Rotational Atherectomy in Heavily Calcified Lesions: Evidence From the Largest Cardiac Center in Thailand

Global Heart
Volume 17 (2022): Issue 1
By: Korakoth Towashiraporn,  Rungroj Krittayaphong,  Damras Tresukosol,  Rewat Phankingthongkum,  Wiwun Tungsubutra,  Nattawut Wongpraparut,  Narathip Chunhamaneewat,  Asa Phichaphop,  Pariya Panchavinnin,  Treenet Reanthong and  Chunhakasem Chotinaiwattarakul  
Open Access
|Oct 2022
Figures & tables

Figures & Tables

Table 1

Baseline clinical characteristics.

BASELINE CLINICAL CHARACTERISTICSALL (n =616)MACCE GROUP (n =39)MACCE-FREE GROUP (n =577)p-VALUE
Age (year) – mean ± SD72.81 ± 9.7170.62 ± 9.4872.96 ± 9.720.145
Sex (Female) – n (%)292 (47.4%)23 (59.0%)269 (46.6%)0.135
BMI (kg/m2) – mean ± SD24.5 ± 4.225.1 ± 4.024.4 ± 4.20.360
Hypertension – n (%)576 (93.5%)38 (97.6%)535 (93.2%)0.502
Cerebrovascular disease – n (%)30 (4.9%)3 (7.7%)27 (4.7%)0.428
Diabetes require insulin therapy – n (%)7 (1.1%)0 (0.0%)7 (1.2%)0.489
Current or ex-smoker – n (%)68 (11.0%)2 (5.1%)66 (11.4%)0.297
Dyslipidemia – n (%)467 (75.8%)29 (74.4%)438 (75.9%)0.827
CKD required hemodialysis – n (%)74 (12.0%)10 (25.6%)64 (11.1%)0.018
History of previous ACS – n (%)118 (19.2%)6 (15.4%)112 (19.4%)0.536
History of previous CABG – n (%)49 (8.0%)7 (17.9%)42 (7.3%)0.028
History of previous PCI – n (%)252 (40.9%)14 (35.9%)238 (41.2%)0.511
LVEF – mean ± SD 155.59 ± 17.4150.88 ± 16.1855.94 ± 17.470.161
Hemoglobin level (g/dL) – mean ± SD 211.72 ± 1.8210.35 ± 2.2511.82 ± 1.75<0.001
Creatinine level (mg/dL) – mean ± SD 31.90 ± 2.052.76 ± 2.751.84 ± 1.970.048
Indication stable CAD – n (%)412 (66.9%)23 (59.0%)389 (67.4%)0.278
Indication NSTE-ACS – n (%)187 (30.4%)14 (35.9%)173 (30.0%)0.437
Indication STEMI – n (%)16 (2.6%)2 (5.1%)14 (2.4%)0.269
Total lesion per patient – mean ± SD1.08 ± 0.271.07 ± 0.261.08 ± 0.270.763

[i] ** Bold indicated statistically significant.

1. 40% of LVEF data were missing 2. 18.3% of serum Hb were imputed. 3. 14.3% of serum Cr were imputed.

ACS – acute coronary syndrome; BMI – body mass index; CABG – coronary artery bypass graft; CKD – chronic kidney disease; LVEF – left ventricular ejection fraction; MACCE – major adverse cardiovascular and cerebrovascular events; NSTE-ACS- non-ST elevation acute coronary syndrome; PCI – percutaneous coronary intervention; SD – standard deviation; STEMI – ST-segment elevation myocardial infarction.

Figure 1

Impact of the clinical presentation and the use of intravascular imaging on the occurrence of MACCE. (A) The clinical presentation of the patients. ACS was the combination of non-ST elevation ACS and ST-segment elevation myocardial infarction. (B) Intravascular imaging consisted of intravascular ultrasound or optical coherence tomography.

ACS – acute coronary syndrome; CAD – coronary artery disease; MACCE – major adverse cardiovascular and cerebrovascular events.

Table 2

Angiographic and procedural characteristics.

CHARACTERISTICSALL (n = 663)MACCE GROUP (n = 43)MACCE-FREE GROUP (n = 620)p-VALUE
Angiographic characteristics
Thrombus (n) – n (%)2 (0.3%)0 (0.0%)2 (0.3%)0.713
Ostial lesion (n) – n (%)113 (18.3%)10 (25.6%)103 (17.9%)0.224
Chronic total occlusion (n) – n (%)46 (7.5%)2 (5.1%)44 (7.6%)0.759
Bifurcation (n) – n (%)194 (31.5%)11 (28.2%)183 (31.7%)0.648
Visible severe calcified coronary artery – n (%)579 (94.0%)37 (94.9%)542 (93.9%)0.811
Procedural characteristics
Femoral access (n) – n (%)445 (72.2%)30 (76.9%)415 (71.9%)0.582

  • Target vessel – n (%)

0.330

  • LM to LAD or LM to LCX

64 (9.7%)3 (7.0%)61 (9.8%)

  • LAD

372 (56.1%)19 (44.2%)353 (56.9%)

  • LCX

59 (8.9%)6 (14.0%)53 (8.5%)

  • RCA

167 (25.2%)15 (34.9%)152 (24.5%)

  • Other

1 (0.2%)0 (0.0%)1 (0.2%)
Target lesion B2 or C – n (%)652 (98.3%)43 (100%)609 (98.2%)0.378
Balloon dilate before RA – n (%)126 (19.0%)8 (18.6%)118 (19.0%)0.945
Post dilate after RA – n (%)569 (85.8%)38 (88.4%)531 (85.6%)0.620
Maximum diameter of postdilatation balloon (mm.) – mean ± SD3.16 ± 0.563.18 ± 0.503.16 ± 0.560.803
Maximum pressure of postdilatation balloon (ATM.) – mean ± SD20.22 ± 5.1021.26 ± 6.0020.14 ± 5.680.243
Maximum Burr size (mm.) – mean ± SD1.55 ± 0.191.52 ± 0.191.55 ± 0.180.372
Use of laser – n (%)2 (0.3%)1 (2.3%)1 (0.2%)0.126
Successful RA – n (%)659 (99.4%)43 (100%)616 (99.4%)0.597
Number of burr(s) (n)0.959

  • 1 – n (%)

542 (81.8%)36 (83.7%)506 (81.7%)

  • 2 – n (%)

119 (17.9%)7 (16.3%)112 (18.1%)
Maximum rotational speed x 10000 RPM – mean ± SD184.88 ± 18.28189.30 ± 11.36184.57 ± 18.630.101
Intravenous pacemaker backup – n (%)50 (7.5%)5 (11.6%)45 (7.3%)0.362
Intra-aortic balloon pump – n (%)26 (3.9%)5 (11.6%)21 (3.4%)0.021
Stent deployment – n (%)632 (95.3%)41 (95.3%)591 (95.3%)0.994
POBA only – n (%)23 (3.5%)0 (0.0%)23 (3.7%)0.390
Drug-eluting stent – n (%)606 (91.4%)41 (95.3%)565 (91.2%)0.582
Diameter of the largest stent (mm.) – mean ± SD3.18 ± 0.503.25 ± 0.523.17 ± 0.500.342
Number of stent(s) – n (%)0.424

  • 0

30 (4.5%)2 (4.7%)28 (4.5%)

  • 1

269 (40.6%)16 (37.2%)253 (40.8%)

  • 2

249 (37.6%)13 (30.2%)236 (38.1%)

  • 3

90 (13.6%)9 (20.9%)81 (13.1%)

  • 4

25 (3.8%)3 (7.0%)212 (3.5%)
Maximum stent length (mm.) – mean ± SD26.68 ± 7.7125.54 ± 6.6226.73 ± 7.770.327
Total stent length in target vessel – mean ± SD41.51 ± 19.1843.24 ± 21.2441.39 ± 19.050.550
Maximum burr size – n (%)0.882

  • 1.25

110 (17.9%)23 (20.0%)87 (17.4%)

  • 1.50

297 (48.4%)56 (48.7%)241 (48.3%)

  • 1.75

196 (31.9%)35 (30.4%)161 (32.3%)

  • 2.00

10 (1.6%)1 (0.9%)9 (1.8%)

  • 2.25

1 (0.2%)0 (0.0%)1 (0.2%)
Intravascular imaging – n (%)455 (73.9%)20 (51.3%)435 (75.4%)0.001
Procedural success – n (%)481 (78.1%)20 (51.3%)461 (79.9%)<0.001
Angiographic success – n (%)584 (94.8%)33 (92.3%)548 (95.0%)0.447
Total procedural time (min) – mean ± SD91.43 ± 45.49110.36 ± 55.1090.15 ± 44.530.007
Total fluoroscopic time (min) – mean ± SD35.16 ± 17.6340.86 ± 16.3134.78 ± 17.670.037
Total contrast volume (ml) – mean ± SD177.24 ± 74.65175.36 ± 77.68177.37 ± 74.500.871

[i] ** Bold indicated statistically significant.

ATM – atmospheric pressure; LAD – left anterior descending coronary artery; LCX – left circumflex coronary artery; LM – left main coronary artery; POBA – plain balloon angioplasty; RA – rotational atherectomy; RCA – right coronary artery; RPM – revolutions per minute.

Figure 2

Intraprocedural and periprocedural complications. (A) intraprocedural complications that occurred during RA. (B) periprocedural complications post-RA.

MI – myocardial infarction; RA – rotational atherectomy.

Figure 3

Major adverse cardiovascular and cerebrovascular events (MACCE) during follow-up. (A) MACCE during 30-days follow-up. (B) MACCE during one-year follow-up.

Table 3

Primary adverse outcomes during the follow-up period.

ADVERSE OUTCOMESTOTAL, n (%)
30-day MACCE – n (%)9 (1.5%)

  • Cardiac death

6 (1.0%)

  • Ischemic stroke

0 (0.0%)

  • Definite stent thrombosis

(0.5%)

  • TLR

2 (0.3%)

  • TVR

3 (0.5%)
1-year MACCE – n (%)39 (6.3%)

  • Cardiac death

10 (1.6%)

  • Ischemic stroke

0 (0.0%)

  • Definite stent thrombosis

17 (2.8%)

  • TLR

22 (3.6%)

  • TVR

29 (4.7%)

[i] MACCE – major adverse cardiovascular and cerebrovascular events; TLR – target lesion revascularization; TVR – target vessel revascularization.

Figure 4

Multivariate analysis adjusted for the independent risk of developing MACCE.

CABG – coronary artery bypass graft; 95% CI – 95% confidence interval; HR – hazard ratio. * 14.3% of serum Cr values were imputed.

Table 4

Comparison of recently published rotational atherectomy registries that were conducted in Asia.

CLINICAL TRIALPOPULATIONNUMBER OF LESIONSACS (%)CENTER(S)COUNTRYANGIOGRAPHIC SUCCESS (%)FOLLOW UP DURATIONCARDIAC DEATH (%)STENT THROMBOSIS (%)TLR (%)TVR (%)STROKE (%)
Lee K et al. [22]54058360.5%Multi-centerKorea96.41.5 years6.91.28.29.82.0
Gao W et al. [23]54054014.6%Single-centerChina96.8In-hospital1.10––0
Okai I et al. [24]1090–15%Multi-centerJapan96.23.8 years10.91.417.7235.1
Ray S et al. [25]144–31.25%Single-centerIndia96.51 year0.7––2.1–
Our registry61666333.1%Single-centerThailand94.81 year1.62.83.64.70

[i] ACS – acute coronary syndrome; TLR – target lesion revascularization; TVR – target vessel revascularization.

DOI: https://doi.org/10.5334/gh.1162 | Journal eISSN: 2211-8179
Journal RSS Feed
Language: English
Submitted on: Feb 15, 2022
Accepted on: Sep 21, 2022
Published on: Oct 25, 2022
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
Debulking the calcified lesion,
percutaneous coronary intervention,
major adverse cardiovascular and cerebrovascular events

© 2022 Korakoth Towashiraporn, Rungroj Krittayaphong, Damras Tresukosol, Rewat Phankingthongkum, Wiwun Tungsubutra, Nattawut Wongpraparut, Narathip Chunhamaneewat, Asa Phichaphop, Pariya Panchavinnin, Treenet Reanthong, Chunhakasem Chotinaiwattarakul, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 17 (2022): Issue 1
Previous article
Next article