Author + information
- Ehrin J. Armstrong,
- Maggie Stanislawski,
- Meg Plomondon,
- Subhash Banerjee and
- Stephen Waldo
Background: Calcified coronary artery lesions are associated with increased procedural complexity, intra-procedural complications, and lower success rates during percutaneous coronary intervention (PCI). Coronary atherectomy may effectively modify calcified lesions, thereby improving procedural success and minimizing the likelihood of intra-procedural complications.
Methods: All patients with calcified coronary artery lesions treated at VA cardiac catheterization laboratories between 2007–2015 were identified. The primary efficacy outcome was intraprocedural success, and the primary safety outcome was intraprocedural complications. Baseline demographic and procedural characteristics were compared, and intra-procedural outcomes were described using unadjusted and propensity-adjusted models.
Results: From October 2007 – September 2015, 87,830 coronary lesions were treated with PCI. Among these, 9,719 (11 %) PCIs were for calcified coronary stenoses in a native vessel, and coronary atherectomy was used for 1,731 (18%) of these calcified lesions. Use of coronary atherectomy was associated with higher rates of procedural success (89% vs. 87%, p=0.007). Among a propensity matched cohort of 3,454 patients, the use of coronary atherectomy was associated with a significantly lower rate of procedural complications (OR: 0.55, 95% CI: 0.37–0.78) as well as peri-procedural clinical complications (OR: 0.55, 95% CI: 0.31–0.97) when compared to those that did not undergo atherectomy. The subsequent rates of target lesion revascularization (HR: 0.94, 95% CI: 0.72– 1.2, N=3376) as well as mortality (HR: 1.19, 95 % CI: 0.98–1.43) did not differ significantly between the matched groups.
Conclusions: Coronary atherectomy is currently used in the minority of PCI for calcified coronary artery lesions, but is associated with improved procedural success and lower in-lab complication rates. Presentation at the meeting will include analysis of temporal trends, utilization of rotational atherectomy vs. orbital atherectomy, and long-term outcomes.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Intervention in Interventional Cardiology: Advanced Device Use
Abstract Category: 21. Interventional Cardiology: Coronary Intervention: Devices
Presentation Number: 1155-153
- 2017 American College of Cardiology Foundation