open access

Ahead of print
Original Article
Published online: 2021-08-02
Get Citation

Long-term outcome of rotational atherectomy according to burr-to-artery ratio and changes in coronary artery blood flow: Observational analysis

Aleksander Nowak, Jakub Ratajczak, Michał Kasprzak, Adam Sukiennik, Tomasz Fabiszak, Wojciech Wojakowski, Andrzej Ochała, Wojciech Wańha, Wacław Kuczmik, Eliano Pio Navarese, Jacek Kubica
DOI: 10.5603/CJ.a2021.0082
·
Pubmed: 34355780

open access

Ahead of print
Original articles
Published online: 2021-08-02

Abstract

Background: Rotational atherectomy (RA) has been proven to be efficient for the treatment of calcified and diffuse coronary artery lesions. However, the optimal burr-to-artery ratio (BtAR) remains unidentified as well as an influence of change in blood flow on long-term outcome. Aim of our study was to examine the association between long-term outcome, and both BtAR and change in coronary flow during RA.

Methods: We conducted a retrospective study including patients who underwent RA. Two independent observers calculated BtAR, pre- and postprocedural corrected Thrombolysis in Myocardial Infarction (TIMI) Frame Count (cTFC) for artery treated with RA. The long-term outcome was defined as all-cause mortality.

Results: Receiver operating characteristic (ROC) curve analysis of BtAR determined threshold of 0.6106 for all-cause mortality detection with sensitivity 50.0%, specificity 90.8%, and area under the curve (AUC) 0.730 (p < 0.001). Kaplan-Meier survival analysis showed that the all-cause mortality rate in the group with the BtAR > 0.6106 is significantly higher compared to the patients with lower BtAR (hazard ratio [HR] 3.76, 95% confidence interval [CI] 1.51–9.32; p < 0.001). Kaplan-Meier survival analysis revealed that the all-cause mortality rate in the group with impairment in coronary flow was significantly higher compared to group with cTFC difference ≤ 0 after RA (HR 3.28, 95% CI 1.56–9.31; p = 0.02).

Conclusions: BtAR > 0.6106 is associated with worse prognosis of patients treated with RA. Patients showing post-RA impairment in blood flow in the target artery have worse prognosis.

Abstract

Background: Rotational atherectomy (RA) has been proven to be efficient for the treatment of calcified and diffuse coronary artery lesions. However, the optimal burr-to-artery ratio (BtAR) remains unidentified as well as an influence of change in blood flow on long-term outcome. Aim of our study was to examine the association between long-term outcome, and both BtAR and change in coronary flow during RA.

Methods: We conducted a retrospective study including patients who underwent RA. Two independent observers calculated BtAR, pre- and postprocedural corrected Thrombolysis in Myocardial Infarction (TIMI) Frame Count (cTFC) for artery treated with RA. The long-term outcome was defined as all-cause mortality.

Results: Receiver operating characteristic (ROC) curve analysis of BtAR determined threshold of 0.6106 for all-cause mortality detection with sensitivity 50.0%, specificity 90.8%, and area under the curve (AUC) 0.730 (p < 0.001). Kaplan-Meier survival analysis showed that the all-cause mortality rate in the group with the BtAR > 0.6106 is significantly higher compared to the patients with lower BtAR (hazard ratio [HR] 3.76, 95% confidence interval [CI] 1.51–9.32; p < 0.001). Kaplan-Meier survival analysis revealed that the all-cause mortality rate in the group with impairment in coronary flow was significantly higher compared to group with cTFC difference ≤ 0 after RA (HR 3.28, 95% CI 1.56–9.31; p = 0.02).

Conclusions: BtAR > 0.6106 is associated with worse prognosis of patients treated with RA. Patients showing post-RA impairment in blood flow in the target artery have worse prognosis.

Get Citation

Keywords

rotational atherectomy, burr-to-artery ratio, corrected Thrombolysis in Myocardial Infarction frame count, mortality

About this article
Title

Long-term outcome of rotational atherectomy according to burr-to-artery ratio and changes in coronary artery blood flow: Observational analysis

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-08-02

DOI

10.5603/CJ.a2021.0082

Pubmed

34355780

Keywords

rotational atherectomy
burr-to-artery ratio
corrected Thrombolysis in Myocardial Infarction frame count
mortality

Authors

Aleksander Nowak
Jakub Ratajczak
Michał Kasprzak
Adam Sukiennik
Tomasz Fabiszak
Wojciech Wojakowski
Andrzej Ochała
Wojciech Wańha
Wacław Kuczmik
Eliano Pio Navarese
Jacek Kubica

References (32)
  1. Barbato E, Carrié D, Dardas P, et al. European expert consensus on rotational atherectomy. EuroIntervention. 2015; 11(1): 30–36.
  2. Tomey MI, Kini AS, Sharma SK. Current status of rotational atherectomy. JACC Cardiovasc Interv. 2014; 7(4): 345–353.
  3. Abdel-Wahab M, Baev R, Dieker P, et al. Long-term clinical outcome of rotational atherectomy followed by drug-eluting stent implantation in complex calcified coronary lesions. Catheter Cardiovasc Interv. 2013; 81(2): 285–291.
  4. Kübler P, Reczuch K. Calcified lesions treated with rotational atherectomy-much more advantages than real hazards. J Thorac Dis. 2018; 10(Suppl 26): S3215–S3217.
  5. Januszek RA, Dziewierz A, Siudak Z, et al. Diabetes and periprocedural outcomes in patients treated with rotablation during percutaneous coronary interventions. Cardiol J. 2020 [Epub ahead of print]; 27(2): 152–161.
  6. Januszek RA, Dziewierz A, Siudak Z, et al. Predictors of periprocedural complications in patients undergoing percutaneous coronary interventions within coronary artery bypass grafts. Cardiol J. 2019; 26(6): 633–644.
  7. Safian RD, Feldman T, Muller DW, et al. Coronary angioplasty and Rotablator atherectomy trial (CARAT): immediate and late results of a prospective multicenter randomized trial. Catheter Cardiovasc Interv. 2001; 53(2): 213–220.
  8. Whitlow P, Bass T, Kipperman R, et al. Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS). Am J Cardiol. 2001; 87(6): 699–705.
  9. Eeckhout E, Kern MJ. The coronary no-reflow phenomenon: a review of mechanisms and therapies. Eur Heart J. 2001; 22(9): 729–739.
  10. Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of 'no-reflow' after percutaneous coronary intervention. Circulation. 1994; 89(6): 2514–2518.
  11. Abbo KM, Dooris M, Glazier S, et al. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol. 1995; 75(12): 778–782.
  12. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation. 2002; 105(5): 656–662.
  13. Cohen BM, Weber VJ, Blum RR, et al. Cocktail attenuation of rotational ablation flow effects (CARAFE) study: pilot. Cathet Cardiovasc Diagn. 1996; Suppl 3: 69–72.
  14. Matsuo H, Watanabe S, Watanabe T, et al. Prevention of no-reflow/slow-flow phenomenon during rotational atherectomy: a prospective randomized study comparing intracoronary continuous infusion of verapamil and nicorandil. Am Heart J. 2007; 154(5): 994.e1–994.e6.
  15. Resnic FS, Wainstein M, Lee MKY, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J. 2003; 145(1): 42–46.
  16. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5): 879–888.
  17. Kaplan BM, Safian RD, Mojares JJ, et al. Optimal burr and adjunctive balloon sizing reduces the need for target artery revascularization after coronary mechanical rotational atherectomy. Am J Cardiol. 1996; 78(11): 1224–1229.
  18. Reffelmann T, Kloner RA. The "no-reflow" phenomenon: basic science and clinical correlates. Heart. 2002; 87(2): 162–168.
  19. Allali A, Abdelghani M, Mankerious N, et al. Feasibility and clinical outcome of rotational atherectomy in patients presenting with an acute coronary syndrome. Catheter Cardiovasc Interv. 2019; 93(3): 382–389.
  20. Cuenza LR, Jayme AC, Khe Sui JHo. Clinical Outcomes of Patients Undergoing Rotational Atherectomy Followed by Drug-eluting Stent Implantation: A Single-center Real-world Experience. Heart Views. 2017; 18(4): 115–120.
  21. Schwartz BG, Mayeda GS, Economides C, et al. Rotational atherectomy and stent implantation for calcified left main lesions. Cardiol Res. 2011; 2(5): 208–217.
  22. Kübler P, Zimoch W, Kosowski M, et al. The use of rotational atherectomy in high-risk patients: results from a high-volume centre. Kardiol Pol. 2018; 76(9): 1360–1368.
  23. Brown AJ, Joshi FR, Cacciottolo P, et al. Coronary rotational atherectomy using burr-to-artery ratios of less than 0.5 is associated with low levels of complications, procedural success rates and favourable 12-month outcomes. Heart. 2013; 99(suppl 2): A39.2–A40.
  24. Cura FA, L'Allier PL, Kapadia SR, et al. Predictors and prognosis of suboptimal coronary blood flow after primary coronary angioplasty in patients with acute myocardial infarction. Am J Cardiol. 2001; 88(2): 124–128.
  25. De Luca G, Ernst N, Zijlstra F, et al. Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol. 2004; 43(8): 1363–1367.
  26. Mehta RH, Harjai KJ, Cox D, et al. Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol. 2003; 42(10): 1739–1746.
  27. Ndrepepa G, Mehilli J, Schulz S, et al. Prognostic significance of epicardial blood flow before and after percutaneous coronary intervention in patients with acute coronary syndromes. J Am Coll Cardiol. 2008; 52(7): 512–517.
  28. Gibson CM, Murphy SA, Rizzo MJ, et al. Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. Thrombolysis In Myocardial Infarction (TIMI) Study Group. Circulation. 1999; 99(15): 1945–1950.
  29. Gibson CM, Cannon CP, Murphy SA, et al. Relationship of the TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to long-term outcomes after thrombolytic administration in acute myocardial infarction. Circulation. 2002; 105(16): 1909–1913.
  30. French JK, Hyde TA, Straznicky IT, et al. Relationship between corrected TIMI frame counts at three weeks and late survival after myocardial infarction. J Am Coll Cardiol. 2000; 35(6): 1516–1524.
  31. Armstrong PW, Fu Y, Chang WC, et al. Acute coronary syndromes in the GUSTO-IIb trial: prognostic insights and impact of recurrent ischemia. The GUSTO-IIb Investigators. Circulation. 1998; 98(18): 1860–1868.
  32. Brener SJ, Barr LA, Burchenal JE, et al. Randomized, placebo-controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acute myocardial infarction. ReoPro and Primary PTCA Organization and Randomized Trial (RAPPORT) Investigators. Circulation. 1998; 98(8): 734–741.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl