Abstract:Aim To analyze the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with different types of acute coronary syndrome (ACS) undergoing coronary artery rotational atherectomy (RA) within two years. Methods 268 patients with ACS who underwent RA in the Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School of Nanjing University, between November 2011 and December 2022 were retrospectively included. According to whether ST-segment elevation myocardial infarction (STEMI) occurred, they were divided into 25 cases in the ST-segment elevation myocardial infarction (STEMI) group and 243 cases in the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) group. The NSTE-ACS group included unstable angina pectoris (UAP) and non-STEMI (NSTEMI). The basic information and intraoperative data related to percutaneous coronary intervention (PCI) in the two groups were collected, and the occurrence of MACCE (including cardiovascular death, non fatal myocardial infarction, worsening heart failure, ischemic stroke and target vessel revascularization) within two years after RA was followed up and analyzed. Results Compared with the NSTE-ACS group, the STEMI group had a higher incidence of MACCE and cardiovascular mortality during the two-year follow-up period (10.3% and 0.4% vs. 28.0% and 8.0%; P＜0.05). There was no statistical difference between the incidence of target vessel revascularization, nonfatal infarction, ischemic stroke and worsening heart failure between the two groups (P＞0.05). According to subgroup analysis based on enrollment periods, the results showed that over time (2011-2017 compared to 2018-2022), the incidence of MACCE in all patients within two years after RA showed a decreasing trend (18.97% vs. 6.58%). Combined with previous studies, gender, hypertension, diabetes, renal insufficiency, smoking and left ventricular ejection fraction (LVEF) were included in the Cox regression model. It was found that the use of intravascular ultrasound (IVUS) was an independent factor to reduce the incidence of MACCE in ACS patients within two years after RA (HR＝0.3,5%CI:0.153～0.723, P＜0.01). Kaplan-Meier analysis showed that among ACS patients undergoing RA, the cumulative incidence of MACCE events was higher in the STEMI group than that in the NSTE-ACS group (P＜0.05). Conclusion STEMI patients have a higher incidence of MACCE and cardiovascular mortality within two years after RA compared to NSTE-ACS patients, and the use of IVUS during RA surgery can reduce the incidence of MACCE in ACS patients after RA.

Abstract:Aim To explore the influential factors of slow flow following rotational atherectomy (RA) and the predictive value of these factors. Methods According to the presence or absence of slow flow (defined as transient thrombolysis in myocardial infarction (TIMI) flow grade ≤2 just after RA), a total of 219 cases undergoing RA were divided into slow flow group (n=50) and non-slow flow group (n=169). The clinical history, laboratory examinations, and coronary intervention data of the two groups were compared. The two-class Logistic regression model was used to analyze independent influential factors of slow flow, the operating characteristic (ROC) curve was used to evaluate the predictive value. Results There were 50 patients (22.8%) in the slow flow group. Compared with the non-slow flow group, the final burr size of 1.25 mm was more used in the slow flow group (P＜0.05), while the final burr size of 1.5 mm was fewer (P＜0.05); Lesion length and total run time were longer, rotation times were higher (P＜0.05); while systolic blood pressure was lower in the slow flow group, and reference diameter was significantly smaller (P＜0.05). The two-class Logistic regression analysis showed that lesion length was an independent risk factor for slow flow, while reference diameter and systolic blood pressure were preventive factors (P＜0.05). Combined use of these variables provided incremental predictive value for slow flow after RA procedure, and the area under the curve was 0.736 with 78.0% sensitivity and 65.1% specificity. Conclusion Lesion length was an independent risk factor of slow flow, while reference diameter and systolic blood pressure were preventive factors, and the combination of these variables provided additional predictive value for slow flow in patients undergoing RA.

Abstract:Aim Rotational atherectomy (RA) is routinely used to treat calcified lesions during percutaneous coronary intervention (PCI), however, PCI related myocardial infarction (PMI) is found in some patients. This study aimed to explore the predictive factors for PMI in patients undergoing RA. Methods 198 patients enrolled in the present study were divided into two groups according to the occurrence of PMI after RA. All the patients received RA prior to drug-eluting stent implantation in severely calcified lesions. The differences of demographic characteristics, hematological profiles, echocardiography parameters and interventional characteristics were compared between the two groups. Predictors for PMI after RA were evaluated using univariable and multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the independent factors. Results Syntax scores, diabetes, family history, low density lipoprotein cholesterol and slow flow were independently associated with PMI in patients undergoing RA. Combined use of these variables provided incremental predictive value for PMI after RA, and the area under the curve was 0.832 with 0.731 sensitivity and 0.823 specificity. Conclusion Syntax scores was an independent predictor for PMI after drug-eluting stent implantation following RA. In addition, combination of diabetes, family history, low density lipoprotein cholesterol and slow flow provided additional predictive value for PMI after RA than Syntax scores alone.

Abstract:Aim To study the efficacy of rotational atherectomy (RA) versus balloon pre-dilated combined with drug eluting stent(DES) implatation in the treatment of heavily calcified coronary lesions. Methods The study selected patients with heavily calcified coronary lesions admitted in Fuyang City Peoples Hospital from October 2017 to October 2018 who were going to receive PCI. The patients were divided into two groups according to the random number table, which were the RA combined with DES group (observation group, n=32) and the balloon pre-dilated combined with DES(control group, n=40). Prospective randomized controlled study was performed. The treatment characteristics and perioperative complications were compared between the two groups. The risk factors of major adverse cardiovascular and cerebrovascular events (MACCE) within 6 months were analyzed. Results The average stent diameter was significantly higher in the observation group than in the control group (3.25 (3.0,3.50) mm vs 3.00 (2.1,3.25) mm, P=0.002). The number of balloon pre-dilated,pre-dilated maximum pressure, the number of balloon post-dilated and post-dilated maximum pressure were significantly lower in the observation group than in the control group(P＜0.05). The lumen diameter after PCI was significantly larger in the observation group than in the control group((3.34±0.28) mm vs (3.15±0.27) mm, P=0.005). The procedural success rate of the observation group (96.9%) was higher than that of the control group (92.9%), the incidence of total MACCE in the observation group (9.4%) was lower than in the control group (22.5%), but there is no significant differences between the two groups(P＞0.05). The previous PCI(risk ration:1.5,5%CI:0.030～0.691, P=0.015) and the maximum pressure of balloon pre-dilated(risk ration:2.6,5%CI:0.721～0.988, P=0.035) were independent risk factors for MACCE within 6 months. Conclusions For severely calcified coronary lesions with a SYNTAX score of 23 to 32, RA has tendencies to improve the procedural success rate and reduce short-term adverse events. The previous PCI and the maximum pressure of pre-dilated were independent risk factors for MACCE within 6 months.

Abstract:Aim To assess the efficiency of rotational atherectomy （RA） with drug-eluting stents （DES） for heavily calcified lesions. Methods By retrospective analysis of 31 cases of severe calcified coronary atherectomy with interventional treatment of patients, 13 patients were carried out under the guidance of intravascular ultrasound （IVUS）, and we analyzed the clinical characteristics, immediate success rate of percutaneous coronary intervention （PCI）, and cardiac events of hospitalization and long-term follow-up results. Results The mean age of 31 patients was 71.81±10.70 years,and 22 patients were male, 9 patients were female. Their coronary artery were confirmed as severely calcified coronary by angiography, including single-vessel disease in 2 cases （6.5%）, double vessel disease in 7 cases （22.6%）, three lesions in 15 cases （48.4%）, left main （LM）＋three lesions in 1 case （3.2%）, LM disease in 6 cases （19.4%）. Rotational atherectomy target vessel in LM-left anterior descending artery （LAD） was 2 cases （6.5%）, LAD was 22 cases （70.9%）, left circumflex artery （LCX） was 2 cases （6.5%）, LAD＋LCX was 1 case （3.2%）, right coronary artery （RCA） was 4 cases （12.9%）. 1 case （3.2%） needed intra-aortic balloon pump （IABP） intraoperation, 6 cases （19.4%） were presented with coronary dissection and 2 cases （6.5%） were with slow flow, but all of them were successfully implemented with rotational atherectomy and stent implantation. Serum troponin T, serum creatine kinase-MB, and serum creatinine had no significant difference. 13 cases were carried out by IVUS, and the minimum lumen diameter, the smallest diameter stenosis rate, the effective area of ？？the lumen had significantly statistical difference pre- and post-operative, respectively（2.0±0.3 mm vs 3.6±0.8 mm, 74.5%±6.8% vs 20.3%±12.5%, 4.0±1.4 mm2 vs 10.7±5.5 mm2, P＝0.000）. With an average follow-up 10.4±6.4 months, no angina, acute myocardial infarction, sudden cardiac death, target vessel revascularization occurred. Conclusions The combination of rotational atherectomy with stents may selectively ablate calcific plaque and may increase the success rate of the PCI.