Five-Year Clinical Outcomes After Drug-Eluting Stent Implantation Following Rotational Atherectomy for Heavily Calcified Lesions
Hiroyuki Jinnouchi, Shoichi Kuramitsu, Tomohiro Shinozaki, Takashi Hiromasa, Yohei Kobayashi, Yasuaki Takeji, Mizuki Miura, Hisaki Masuda, Yukiko Matsumura, Yuhei Yamaji, Kenichi Sakakura, Takenori Domei, Yoshimitsu Soga, Makoto Hyodo, Shinichi Shirai, Kenji Ando, Hiroyuki Jinnouchi, Shoichi Kuramitsu, Tomohiro Shinozaki, Takashi Hiromasa, Yohei Kobayashi, Yasuaki Takeji, Mizuki Miura, Hisaki Masuda, Yukiko Matsumura, Yuhei Yamaji, Kenichi Sakakura, Takenori Domei, Yoshimitsu Soga, Makoto Hyodo, Shinichi Shirai, Kenji Ando
Abstract
Background: Percutaneous coronary intervention for heavily calcified lesions requires rotational atherectomy (RA). Long-term clinical outcomes after drug-eluting stent (DES) implantation following (RA) for heavily calcified lesions remain unclear. We assessed 5-year clinical outcomes after DES implantation following RA.Methods and Results:Between March 2006 and September 2011, 219 consecutive patients with 219 lesions treated with DES following RA, were retrospectively enrolled. The cumulative 5-year incidence of target-lesion revascularization (TLR) and definite stent thrombosis (ST) were assessed. The cumulative incidence of TLR within (≤) the first year was 18.6%. Late TLR beyond (>) 1 year continued to occur at 1.9% per year without a decrease in the rate (5-year incidence, 26.0%). The cumulative incidence of definite ST at 30 days, 1 and 5 years was 0.9%, 2.3% and 2.9%, respectively. The annual rate of definite ST beyond 1 year was 0.15%. On multivariate analysis, the significant predictor of TLR within 1 year was use of first-generation DES (hazard ratio [HR], 2.09; 95% CI: 1.10-4.03, P=0.02) and that of TLR beyond 1 year was hemodialysis (HR, 3.29; 95% CI: 1.06-10.55, P=0.04).
Conclusions: Late TLR beyond 1 year continued to occur up to 5 years at a constant annual incidence, whereas very late ST was rare. Careful long-term clinical follow-up is continually needed in patients who have already received DES following RA for heavily calcified lesions.
Keywords: Calcification; Drug-eluting stent; Percutaneous coronary intervention; Rotational atherectomy.
Source: PubMed