Author + information
- Barbara Anna Daneka,b,
- Aris Karatasakisa,b,
- Judit Karacsonyia,b,
- Waleed Alharbia,b,
- Michele Roeslea,b,
- Bavana Rangana,b,
- M. Nicholas Burkea,b,
- Subhash Banerjeea,b and
- Emmanouil Brilakisa,b
Background: Outcomes with coronary lesion modification in the drug-eluting stent era have received limited study.
Methods: We examined 21 studies from 2004-2016 with outcomes of 244,665 patients after atherectomy (rotational or orbital) or cutting/scoring balloon.
Results: In observational trials, acute luminal gain was higher after lesion modification (mean difference 0.278 [0.018-0.538], p=0.036), with no difference in randomized controlled trials (RCTs). Restenosis was similar in observational trials, but lower in RCTs (OR 0.64 [0.45-0.90], p=0.010). The 90-day incidence of major adverse cardiovascular events (MACE) was higher in observational studies (OR 1.39 [1.05–1.83], p=0.022), but similar in RCTs. There was no difference in target lesion/vessel revascularization (TLR-TVR) or myocardial infarction (MI). Death was more frequent after lesion modification in observational studies (OR 1.42 [1.04–1.95], p=0.029) with difference in RCTs. At 1 year, MACE after lesion modification was similar to control in observational studies, but lower after lesion modification in RCTs (OR 0.66 [0.48-0.89], p=0.006) (Figure 1A). TLR-TVR was higher with lesion modification in observational studies, but lower in RCTs (OR 0.64 [0.46-0.88], p=0.006) (Figure 1B). There was no difference in other outcomes at 1 year (Figure 1C, D).
Conclusions: Observational studies suggest higher early MACE and more restenosis, but RCTs show similar short-term and improved long-term outcomes after lesion modification.
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: 1155-160
- 2017 American College of Cardiology Foundation