Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support

Whiteside, Hoyle; Ratanapo, Supawat; Nagabandi, Arun; Kapoor, Deepak A.

doi:10.1016/j.carrev.2018.02.008

Cited by 10 publications

(14 citation statements)

References 33 publications

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“…Indeed, this is a much higher rate than in our analysis, with a total incidence of peri-procedural MI of 2.5%, but one should consider the usage of the CMR with its high sensitivity and specificity for MI detection in combination with troponin increase. In two other recent studies by Watanabe et al [18] and Whiteside et al [19], slow flow was significantly higher in severely reduced LVEF patients [defined as ≤ 35% by Watanabe et al ( n = 33) and as ≤ 30% by Whiteside et al ( n = 18)].…”

Section: Discussionmentioning

confidence: 88%

Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study

et al. 2019

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IntroductionRotational atherectomy (RA) historically was contraindicated in patients with impaired left ventricular (LV) function due to inherent cardio-depressive effects. Contemporary RA practice is less aggressive than traditional RA and no longer withheld from patients with reduced ejection fraction (EF). The aim of this analysis is to explore the outcomes of rotational atherectomy (RA) in patients with reduced left ventricular ejection fraction (LVEF).MethodsPatients undergoing RA (n = 644) were divided into three groups according to LVEF (severely reduced ≤ 35%, n = 82; moderately reduced 36–54%, n = 170; and preserved LVEF ≥ 55%, n = 392).ResultsCompared to patients with preserved LVEF, those with severely reduced LVEF had higher rates of angiographic failure (12.2 vs. 3.3%, p = 0.003) and in-hospital major adverse cardiac events (MACE: 9.8 vs. 2.3%, p = 0.004) driven by more peri-procedural myocardial infarction (MI: 6.1 vs. 1.5%, p = 0.049). In-hospital outcomes were similar between patients with preserved and moderately reduced LVEF. At 5-year follow-up, a stepwise increase in all-cause death was observed with lower LVEF (preserved: 15%, moderately reduced: 23%, severely reduced: 43%; p < 0.001). On the other hand, revascularization and MI rates at 5 years were not affected by LVEF.ConclusionsCompared to patients with preserved LVEF, those with severely reduced LVEF have worse acute outcomes after RA, whereas a moderate reduction of LVEF poses no additional acute hazard after RA. Up to 5 years, the extent of left ventricular dysfunction was associated with a stepwise increase in mortality.Electronic supplementary materialThe online version of this article (10.1007/s40119-019-0143-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 88%

Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study

et al. 2019

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“…Higher risk RA procedures involve significant vessel tortuosity, severe left ventricular dysfunction or other anatomical features (ie: target lesion in a retroflexed circumflex artery, increasing the risk of burr entrapment or perforation). RA has been shown to be safe using both radial and femoral access [14] and even in high-risk patients; such as those with severe aortic stenosis [15] and severe left ventricular dysfunction [16]. The MAUDE database recently revealed that dissection and perforation were the most commonly reported vessel-related complications, however, this database is limited by self-reporting [17].…”

Section: Rotational Atherectomymentioning

confidence: 99%

Percutaneous management of calcified coronary arteries – review of atherectomy and lithotripsy devices and why it is important

Burke

Graham²

2021

Current Opinion in Cardiology

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Purpose of reviewCoronary artery calcification (CAC) predisposes to suboptimal revascularization outcomes after percutaneous coronary intervention (PCI). Despite the availability of several plaque modification devices, their rates of use remain low despite the prevalence of CAC encountered in clinical practice. It is important to understand how each device can be utilized in clinical practice in order to improve outcomes after PCI. Recent findingsThis article summarizes the most recent clinical evidence for each plaque modification device. Although rotational atherectomy is the most frequently used device for plaque modification, the use of orbital atherectomy (OA) has been increasing. Balloon-based strategies including recent studies evaluating a novel intravascular lithotripsy balloon have shed light on the benefits of nonablative devices in modifying CAC during PCI. SummaryCAC poses significant technical challenges in achieving optimal stent results. Several intracoronary plaque modification devices are currently available and understanding the technical aspects, indications and contraindications to the use of each device is essential. Although rotational and OA are most commonly used, laser atherectomy and balloon-based devices may offer an advantage in certain lesion subsets.

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“…Second, the percentage of patients with an impaired LVEF who underwent RA in our study was lower than that reported in a previous study (one-sixth compared with one-fourth to one-third of patients). 10,11 This implies that the study population might have been selective, with possibly biased results. Furthermore, patients with severe left ventricular dysfunction (LVEF of 25%) were not included in the present study; therefore, the outcomes in these patients remain unclear.…”

Section: Study Limitationsmentioning

confidence: 99%

“…9 Patients with a reduced left ventricular ejection fraction (LVEF) account for one-fourth to onethird of those undergoing RA. 10,11 A reduced LVEF is reportedly an independent predictor of adverse clinical events in patients undergoing PCI. 12 This population represents a high-risk group because such patients are more often faced with the threats of periprocedural complications of RA, including procedural hypotension that may require hemodynamic support.…”

Section: Introductionmentioning

confidence: 99%

“…12 This population represents a high-risk group because such patients are more often faced with the threats of periprocedural complications of RA, including procedural hypotension that may require hemodynamic support. 11 The outcomes of patients with an impaired LVEF who undergo orbital atherectomy have been previously described, 13 but data on the safety and efficacy of RA in patients with a severely reduced LVEF remain limited. Therefore, we analyzed the in-hospital and 2-year clinical outcomes in patients with a reduced LVEF who underwent RA in this retrospective investigation.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of coronary rotational atherectomy in patients with reduced left ventricular ejection fraction

Zhang

Zhao

et al. 2019

J Int Med Res

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Objective We evaluated the safety and efficacy of rotational atherectomy (RA) in patients with a reduced left ventricular ejection fraction (LVEF). Methods In total, 140 consecutive patients with severe coronary artery calcification (CAC) who underwent RA were retrospectively enrolled. Patients were grouped based on LVEF: ≤35% (n = 10), 36% to 50% (n = 11), and >50% (n = 119). We assessed procedural success and periprocedural complication rates as well as the incidences of in-hospital and 2-year major adverse cardiac events (MACEs), defined as hospitalization for myocardial infarction and worsening heart failure, target vessel revascularization, and cardiac death. Results Procedural success was achieved in nearly all patients in each group. Most periprocedural complications were minor, and major complications were uncommon. The 2-year MACE rate was significantly higher in the LVEF ≤35% than LVEF >50% group (40.0% vs. 6.7%, respectively). Multivariable regression analysis revealed that the LVEF was the only independent predictor of 2-year MACEs in patients who underwent RA. Conclusions Patients with a reduced LVEF who underwent RA had procedural success rates similar to those of patients with preserved left ventricular systolic function. The LVEF might be an independent predictor of 2-year MACEs in patients with severe CAC after percutaneous coronary intervention following RA.

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Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support

Cited by 10 publications

References 33 publications

Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study

Acute and Long-Term Outcomes of Patients with Impaired Left Ventricular Systolic Function Undergoing Rotational Atherectomy: A Single-Center Observational Retrospective Study

Percutaneous management of calcified coronary arteries – review of atherectomy and lithotripsy devices and why it is important

Outcomes of coronary rotational atherectomy in patients with reduced left ventricular ejection fraction

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