Intravascular Imaging Guidance Reduce 1-Year MACE in Patients Undergoing Rotablator Atherectomy-Assisted Drug-Eluting Stent Implantation

Abstract

Objectives: This study aimed to investigate the incidence of 1-year major adverse cardiac events (MACE) compared between intravascular imaging guidance and angiographic guidance in patients undergoing rotablator atherectomy (RA)-assisted percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation.Methods: This retrospective analysis included 265 consecutive patients with heavy calcified lesion who underwent RA-assisted PCI with DES implantation at our institution during the January 2016-December 2018 study period. This study was approved by the Siriraj Institutional Review Board. Patients were divided into either the angiographic guidance PCI group or the imaging guidance PCI group, which was defined as intravascular ultrasound or optical coherence tomography. The primary endpoint was 1-year MACE.Results: Two hundred and sixty-five patients were enrolled, including 188 patients in the intravascular imaging guidance group, and 77 patients in the angiographic guidance group. One-year MACE was significantly lower in the imaging guidance group compared to the angiographic guidance group (4.3 vs. 28.9%, respectively; odds ratio (OR): 9.06, 95% CI: 3.82–21.52; p < 0.001). The 1-year rates of all-cause death (OR: 8.19, 95% CI: 2.15–31.18; p = 0.002), myocardial infarction (MI) (OR: 6.13, 95% CI: 2.05–18.3; p = 0.001), and target vessel revascularization (TVR) (OR: 3.67, 95% CI: 1.13–11.96; p = 0.031) were also significantly lower in the imaging guidance group compared with the angiographic guidance group. The rate of stroke was non-significantly different between groups.Conclusion: In patients with heavy calcified lesion undergoing RA-assisted DES implantation, the intravascular imaging guidance significantly reduced the incidence of 1-year MACE, all-cause death, MI, and TVR compared to the angiographic guidance.

Characteristics and Pattern of Calcified Nodule and/or Nodular Calcification Detected by Intravascular Ultrasound on the Device-Oriented Composite Endpoint (DoCE) in Patients with Heavily Calcified Lesions Who Underwent Rotational Atherectomy-Assisted Percutaneous Coronary Intervention

“…Intravascular ultrasound (IVUS) has a significant role in assisted coronary and noncoronary intervention [ 4 – 12 ]. Intravascular imaging guidance reduce 1 year MACE in the patients with heavy calcified lesion undergoing RA-assisted PCI [ 13 ]. Information obtained from intravascular ultrasound (IVUS) specific to the presence and characteristics of a CN/NC within a heavily calcified lesion that impact on device-oriented composite endpoint (DoCE) will improve patient management and clinical outcomes.…”

The Usefulness of Intravascular Ultrasound and Optical Coherence Tomography in Patients Treated with Rotational Atherectomy: An Analysis Based on a Large National Registry

“…The postprocedural assessment improves stent expansion and apposition as well as the detection of procedure-related complications. Although the utility of intravascular imaging depends on patients’ cohort characterization, the improvements of long-term clinical outcomes are generally well supported, particularly in severely calcified and complex lesions [ 14 , 16 , 28 , 29 , 30 ]. However, some studies encompassing both an all-comers cohort of patients and specific populations did not find significant improvements in the long-term endpoints (including MACE, target vessel revascularization, and definite stent thrombosis) following the introduction of intravascular imaging [ 31 , 32 ].…”

“…The usefulness of IVUS and OCT among patients undergoing PCI of calcified coronary lesions has been demonstrated in several studies [ 14 , 15 , 16 , 17 ]. RA is an effective technique for calcified plaques, facilitating stent delivery and implantation.…”

Current role of intravascular imaging in percutaneous treatment of calcified coronary lesions

“…Procedural data analysis shows that ICI guidance increases the number of burrs used (1.210 ±0.42 vs 1.070 ±0.31; p = 0.005) and the final diameter (1.50 mm (1.50-1.75) vs 1.50 mm (1.25-1.50); p = 0.001), as well as the length of the implanted stent (38.0 mm (30.0-53.7) vs 33.0 mm (22.0-49.0); p = 0.004) and its diameter 3.00 mm (3.00-3.50) vs. 2.75 mm (2.50-3.50); p < 0.001). 62 Interventional cardiologists have multiple parameters to consider during CAC PCI, which are summarized in Table 2. Two studies on OCT vs IVUS-guided RA PCI showed better results using the former modality.…”