Long-term clinical outcomes of permanent-polymer everolimus-eluting stent implantation following rotational atherectomy for severely calcified de novo coronary lesions: Results of a 22-center study (Tokyo-MD PCI Study)

• Published in: Cardiovascular revascularization medicine 2019-02, Vol.20 (2), p.120-125
• Main Authors: Otaki, Yoichi, Ashikaga, Takashi, Sasaoka, Taro, Kurihara, Ken, Yoshikawa, Shunji, Isobe, Mitsuaki
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Atherectomy, Coronary - adverse effects; Atherectomy, Coronary - mortality; Calcified coronary lesion; Cardiovascular Agents - administration & dosage; Cardiovascular Agents - adverse effects; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Drug-Eluting Stents; Everolimus - administration & dosage; Everolimus - adverse effects; Everolimus-eluting stent; Female; Hemodialysis; Humans; Incidence; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Polymers; Prosthesis Design; Renal Dialysis - adverse effects; Retrospective Studies; Risk Assessment; Risk Factors; Rotational atherectomy; Severity of Illness Index; Time Factors; Tokyo - epidemiology; Treatment Outcome; Vascular Calcification - diagnostic imaging; Vascular Calcification - mortality; Vascular Calcification - therapy
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2018.04.022

Long-term clinical outcomes of permanent polymer everolimus-eluting stent (PP-EES) implantation after rotational atherectomy (RA) have not been fully evaluated. We sought to investigate the long-term clinical outcomes of PP-EES implantation after RA and assess the impact of hemodialysis on this treatment strategy. Patients who underwent percutaneous coronary intervention (PCI) with PP-EES at 22 institutions between January 2010 and December 2011 were enrolled in this multicenter, observational trial. From a total of 1918 registered patients, 113 patients with 115 de-novo lesions who underwent PCI with PP-EES following RA were retrospectively analyzed. The primary endpoint was a major adverse cardiac event (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically driven target lesion revascularization (TLR). Long-term follow-up was available for 112 patients (99.1%). The median follow-up period was 2.9 (interquartile range 1.9–3.6) years. The mean age of the patients was 72.3 ± 8.8 years and 64 patients (56.6%) had chronic kidney disease (≥stage 3, 42 on hemodialysis). The cumulative incidences of MACE, non-fatal MI, and TLR were 22.1%, 5.3%, and 10.6%, respectively. Cox's proportional hazards analysis showed that the independent predictors of TLR were hemodialysis and chronic total occlusion. (HR, 14.1; 95% CI, 1.74–155.5; p = 0.01, HR, 9.01; 95% CI, 1.34–62.5; p = 0.02). PP-EES implantation after lesion modification by RA is considered to be a feasible treatment strategy for heavily calcified lesions. Hemodialysis and chronic total occlusion appeared to be associated with TLR. •PP-EES implantation after RA is considered to be a feasible treatment strategy.•The rate of TLR after PP-EES placement following RA was not as high as RA-1st generation DES studies including HD patients.•HD and CTO were associated with TLR after PP-EES implantation following RA.