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Impact of chronic total occlusion lesions on clinical outcomes in patients receiving rotational atherectomy: results from the ROCK registry

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Abstract

The aim of this study was to investigate the impact of chronic total occlusion (CTO) on clinical outcomes in patients with calcified coronary lesions receiving rotational atherectomy (RA). This multi-center registry enrolled consecutive patients with calcified coronary artery disease who underwent RA during percutaneous coronary intervention (PCI) from 9 tertiary centers in Korea between January 2010 and October 2019. The primary outcome was target-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR). A total of 583 lesions were enrolled in this registry and classified as CTO (n = 42 lesions, 7.2%) and non-CTO (n = 541 lesions, 92.8%). The CTO group consisted of younger patients who were more likely to have a history of previous percutaneous coronary intervention or coronary artery bypass graft surgery. The incidence of the primary outcome was 14.1% and 16.7% for the non-CTO group and CTO group, respectively. The primary outcomes observed in the two groups were not significantly different (log-rank p = 0.736). The 18-month clinical outcomes of the CTO group were comparable to those of the non-CTO group in multivariate analysis. About 7% of patients requiring RA have CTO lesions and these patients experience similar clinical outcomes compared with those having non-CTO lesions. Use of RA for CTO lesions was safe despite higher procedural complexity.

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References

  1. Tsai TT, Stanislawski MA, Shunk KA, Armstrong EJ, Grunwald GK, Schob AH, Valle JA, Alfonso CE, Nallamothu BK, Ho PM, Rumsfeld JS, Brilakis ES (2017) Contemporary incidence, management, and long-term outcomes of percutaneous coronary interventions for chronic coronary artery total occlusions: insights from the VA CART program. JACC Cardiovasc Interv 10:866–875

    Article  Google Scholar 

  2. Williams DO, Holubkov R, Yeh W, Bourassa MG, Al-Bassam M, Block PC, Coady P, Cohen H, Cowley M, Dorros G, Faxon D, Holmes DR, Jacobs A, Kelsey SF, King SB 3rd, Myler R, Slater J, Stanek V, Vlachos HA, Detre KM (2000) Percutaneous coronary intervention in the current era compared with 1985–1986: the National Heart, Lung, and Blood Institute Registries. Circulation 102:2945–2951

    Article  CAS  Google Scholar 

  3. Anderson HV, Shaw RE, Brindis RG, Hewitt K, Krone RJ, Block PC, McKay CR, Weintraub WS (2002) A contemporary overview of percutaneous coronary interventions. The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). J Am Coll Cardiol 39:1096–1103

    Article  Google Scholar 

  4. Puma JA, Sketch MH Jr, Tcheng JE, Harrington RA, Phillips HR, Stack RS, Califf RM (1995) Percutaneous revascularization of chronic coronary occlusions: an overview. J Am Coll Cardiol 26:1–11

    Article  CAS  Google Scholar 

  5. Hoye A, van Domburg RT, Sonnenschein K, Serruys PW (2005) Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992–2002. Eur Heart J 26:2630–2636

    Article  Google Scholar 

  6. Pagnotta P, Briguori C, Mango R, Visconti G, Focaccio A, Belli G, Presbitero P (2010) Rotational atherectomy in resistant chronic total occlusions. Catheter Cardiovasc Interv 76:366–371

    Article  Google Scholar 

  7. Stone GW, Colombo A, Teirstein PS, Moses JW, Leon MB, Reifart NJ, Mintz GS, Hoye A, Cox DA, Baim DS, Strauss BH, Selmon M, Moussa I, Suzuki T, Tamai H, Katoh O, Mitsudo K, Grube E, Cannon LA, Kandzari DE, Reisman M, Schwartz RS, Bailey S, Dangas G, Mehran R, Abizaid A, Serruys PW (2005) Percutaneous recanalization of chronically occluded coronary arteries: procedural techniques, devices, and results. Catheter Cardiovasc Interv 66:217–236

    Article  Google Scholar 

  8. Cavusoglu E, Kini AS, Marmur JD, Sharma SK (2004) Current status of rotational atherectomy. Catheter Cardiovasc Interv 62:485–498

    Article  Google Scholar 

  9. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O’Gara PT, Sabatine MS, Smith PK, Smith SC Jr (2016) 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation 134:e123-155

    Article  Google Scholar 

  10. Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW (2013) Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI). J Am Coll Cardiol 62:1563–1570

    Article  Google Scholar 

  11. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992

    Article  CAS  Google Scholar 

  12. Kuntz RE, Safian RD, Carrozza JP, Fishman RF, Mansour M, Baim DS (1992) The importance of acute luminal diameter in determining restenosis after coronary atherectomy or stenting. Circulation 86:1827–1835

    Article  CAS  Google Scholar 

  13. Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, Gaglione A, Goldberg SL, Tobis JM (1995) Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 91:1676–1688

    Article  CAS  Google Scholar 

  14. Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A (1997) Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J Am Coll Cardiol 29:6–12

    Article  CAS  Google Scholar 

  15. Vavuranakis M, Toutouzas K, Stefanadis C, Chrisohou C, Markou D, Toutouzas P (2001) Stent deployment in calcified lesions: can we overcome calcific restraint with high-pressure balloon inflations? Catheter Cardiovasc Interv 52:164–172

    Article  CAS  Google Scholar 

  16. Vliegenthart R, Oudkerk M, Hofman A, Oei HH, van Dijck W, van Rooij FJ, Witteman JC (2005) Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation 112:572–577

    Article  Google Scholar 

  17. Brogan WC 3rd, Popma JJ, Pichard AD, Satler LF, Kent KM, Mintz GS, Leon MB (1993) Rotational coronary atherectomy after unsuccessful coronary balloon angioplasty. Am J Cardiol 71:794–798

    Article  Google Scholar 

  18. Rosenblum J, Stertzer SH, Shaw RE, Hidalgo B, Hansell HN, Murphy MC, Myler RK (1992) Rotational ablation of balloon angioplasty failures. J Invasive Cardiol 4:312–318

    CAS  PubMed  Google Scholar 

  19. Whitbourn RJ, Sethi R, Pomerantsev EV, Fitzgerald PJ (2003) High-speed rotational atherectomy and coronary stenting: QCA and QCU analysis. Catheter Cardiovasc Interv 60:167–171

    Article  Google Scholar 

  20. Tomey MI, Kini AS, Sharma SK (2014) Current status of rotational atherectomy. JACC Cardiovasc Interv 7:345–353

    Article  Google Scholar 

  21. Suero JA, Marso SP, Jones PG, Laster SB, Huber KC, Giorgi LV, Johnson WL, Rutherford BD (2001) Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol 38:409–414

    Article  CAS  Google Scholar 

  22. Olivari Z, Rubartelli P, Piscione F, Ettori F, Fontanelli A, Salemme L, Giachero C, Di Mario C, Gabrielli G, Spedicato L, Bedogni F (2003) Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol 41:1672–1678

    Article  Google Scholar 

  23. Prasad A, Rihal CS, Lennon RJ, Wiste HJ, Singh M, Holmes DR Jr (2007) Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: a 25-year experience from the Mayo Clinic. J Am Coll Cardiol 49:1611–1618

    Article  Google Scholar 

  24. Stone GW, Reifart NJ, Moussa I, Hoye A, Cox DA, Colombo A, Baim DS, Teirstein PS, Strauss BH, Selmon M, Mintz GS, Katoh O, Mitsudo K, Suzuki T, Tamai H, Grube E, Cannon LA, Kandzari DE, Reisman M, Schwartz RS, Bailey S, Dangas G, Mehran R, Abizaid A, Moses JW, Leon MB, Serruys PW (2005) Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part II. Circulation 112:2530–2537

    Article  Google Scholar 

  25. Sievert H, Rohde S, Ensslen R, Merle H, Scherer D, Spies H, Schulze R, Utech A (1996) Recanalization of chronic coronary occlusions using a laser wire. Cathet Cardiovasc Diagn 37:220–222

    Article  CAS  Google Scholar 

  26. Fang HY, Fang CY, Hussein H, Hsueh SK, Yang CH, Chen CJ, Hsieh YK, Hang CL, Yip HK, Wu CJ (2010) Can a penetration catheter (Tornus) substitute traditional rotational atherectomy for recanalizing chronic total occlusions? Int Heart J 51:147–152

    Article  Google Scholar 

  27. Huang WC, Teng HI, Chan WL, Lu TM (2018) Short-term and long-term clinical outcomes of rotational atherectomy in resistant chronic total occlusion. J Interv Cardiol 31:458–464

    Article  Google Scholar 

  28. Azzalini L, Dautov R, Ojeda S, Serra A, Benincasa S, Bellini B, Giannini F, Chavarría J, Gheorghe LL, Pan M, Carlino M, Colombo A, Rinfret S (2017) Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions. Catheter Cardiovasc Interv 89:820–828

    Article  Google Scholar 

  29. Xenogiannis I, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Choi JW, Burke MN, Doing AH, Dattilo P, Toma C, Smith AJC, Uretsky B, Krestyaninov O, Khelimskii D, Holper E, Potluri S, Wyman RM, Kandzari DE, Garcia S, Koutouzis M, Tsiafoutis I, Khatri JJ, Jaber W, Samady H, Jefferson BK, Patel T, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Tajti P, Rangan BV, Abdullah S, Banerjee S, Brilakis ES (2019) Usefulness of atherectomy in chronic total occlusion interventions (from the PROGRESS-CTO Registry). Am J Cardiol 123:1422–1428

    Article  Google Scholar 

  30. Brinkmann C, Eitan A, Schwencke C, Mathey DG, Schofer J (2018) Rotational atherectomy in CTO lesions: too risky? Outcome of rotational atherectomy in CTO lesions compared to non-CTO lesions. EuroIntervention 14:e1192–e1198

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea

    Su Nam Lee, Sung-Ho Her, Won Young Jang, Donggyu Moon, Keon-Woong Moon & Ki-Dong Yoo

  2. Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Kyusup Lee

  3. Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea

    Ik Jun Choi

  4. Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea

    Jae Hwan Lee

  5. Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Republic of Korea

    Jang Hoon Lee

  6. Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Republic of Korea

    Sang Rok Lee

  7. Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Seung-Whan Lee

  8. Division of Cardiology, Department of Internal Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea

    Kyeong Ho Yun

  9. Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea

    Hyun-Jong Lee

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  1. Su Nam Lee
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Correspondence to Sung-Ho Her.

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Lee, S.N., Her, SH., Jang, W.Y. et al. Impact of chronic total occlusion lesions on clinical outcomes in patients receiving rotational atherectomy: results from the ROCK registry. Heart Vessels 36, 1617–1625 (2021). https://doi.org/10.1007/s00380-021-01849-4

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