Outcomes After Successful Percutaneous Coronary Intervention of Calcified Lesions Using Rotational Atherectomy, Cutting-Balloon Angioplasty, or Balloon-Only Angioplasty Before Drug-Eluting Stent Implantation

Björn Redfors, Akiko Maehara, Bernhard Witzenbichler, Giora Weisz, Thomas D Stuckey, Timothy D Henry, Thomas McAndrew, Roxana Mehran, Ajay J Kirtane, Gregg W Stone, Philippe Généreux
Journal of Invasive Cardiology 2017, 29 (11): 378-386

OBJECTIVES: To report adverse event rates after rotational atherectomy (RA) with contemporary drug-eluting stent (DES) implantation and compare RA to cutting balloon (CB) angioplasty and balloon-only angioplasty (BA) in the all-comers ADAPT-DES trial.

BACKGROUND: Percutaneous coronary intervention (PCI) of calcified lesions is increasingly common and is associated with a high risk of adverse events. RA can ablate calcified plaque and facilitate stent delivery; however, in conjunction with first-generation DES, RA was not superior to BA alone in regard to adverse events.

METHODS: ADAPT-DES enrolled 8582 patients who underwent successful PCI with DES, of whom 2644 had calcified target lesions and were included in this study. Among these patients, 1610 had exclusively second-generation DESs implanted. We present Kaplan-Meier rates for the primary endpoint of target-vessel failure (TVF; defined as death, myocardial infarction, or target-vessel revascularization) as well as its components, for patients who had RA, CB, or BA.

RESULTS: Among the 2644 patients, RA and CB were used in 150 patients (5.7%) and 53 patients (2.0%), respectively. TVF occurred in 20.8% of the RA patients, 24.1% of the CB patients, and 17.9% of the BA patients over the 2-year study period (P=.41) and was primarily driven by target-vessel revascularization (13.8%, 11.4%, and 10.2%, respectively). RA patients with acute coronary syndromes had nominally higher 2-year TVF rates than RA patients with stable coronary artery disease.

CONCLUSION: TVF is common after contemporary DES-PCI of calcified lesions, independent of the technique used to prepare the vessel for stent implantation. Better treatment strategies are needed.

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