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Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study.

Publication ,  Journal Article
Cohen, MG; Ghatak, A; Kleiman, NS; Naidu, SS; Massaro, JM; Kirtane, AJ; Moses, J; Magnus Ohman, E; Džavík, V; Palacios, IF; Heldman, AW ...
Published in: Catheter Cardiovasc Interv
June 1, 2014

OBJECTIVE: To study rotational atherectomy (RA) outcomes in patients undergoing high-risk PCI randomized to receive hemodynamic support using either IABP or Impella 2.5 in the PROTECT II trial. BACKGROUND: RA of heavily calcified lesions is often necessary for complex PCI but can be associated with slow-flow, hypotension, and higher risk of periprocedural MI. METHODS: We compared baseline, angiographic, procedural characteristics, and outcomes of patients treated with and without RA. We examined also RA technique and outcomes. RESULTS: RA was used in 52 of 448 patients (32 with Impella vs 20 with IABP, P = 0.08). RA patients were older (72 vs. 67 yo, P = 0.0009), more likely to have prior CABG (48 vs. 32%, P = 0.017), higher STS (8.1 vs. 5.7, P = 0.012) and higher SYNTAX scores (37 vs. 29, P < 0.0001). At 90 days, RA use was associated with higher incidence of MI but no mortality difference. RA was used more aggressively with Impella resulting in higher rate of periprocedural MI (P < 0.01), with no difference in mortality between groups (P = 0.78). Repeat revascularization occurred less frequently with Impella (P < 0.001). There were no differences in 90-day major adverse events between IABP and Impella in patients undergoing RA (P = 0.29). In patients not treated with RA, fewer MAEs were observed with Impella compared with IABP (P = 0.03). CONCLUSIONS: Patients who were treated with RA had more comorbidities, and more complex and extensive coronary artery disease. In patients with Impella, more aggressive RA use resulted in fewer revascularization events but higher incidence of periprocedural MI.

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Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

June 1, 2014

Volume

83

Issue

7

Start / End Page

1057 / 1064

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Prospective Studies
  • Plaque, Atherosclerotic
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Male
  • Incidence
 

Citation

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Cohen, M. G., Ghatak, A., Kleiman, N. S., Naidu, S. S., Massaro, J. M., Kirtane, A. J., … O’Neill, W. W. (2014). Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study. Catheter Cardiovasc Interv, 83(7), 1057–1064. https://doi.org/10.1002/ccd.25277
Cohen, Mauricio G., Abhijit Ghatak, Neal S. Kleiman, Srihari S. Naidu, Joseph M. Massaro, Ajay J. Kirtane, Jeffrey Moses, et al. “Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study.Catheter Cardiovasc Interv 83, no. 7 (June 1, 2014): 1057–64. https://doi.org/10.1002/ccd.25277.
Cohen MG, Ghatak A, Kleiman NS, Naidu SS, Massaro JM, Kirtane AJ, et al. Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study. Catheter Cardiovasc Interv. 2014 Jun 1;83(7):1057–64.
Cohen, Mauricio G., et al. “Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study.Catheter Cardiovasc Interv, vol. 83, no. 7, June 2014, pp. 1057–64. Pubmed, doi:10.1002/ccd.25277.
Cohen MG, Ghatak A, Kleiman NS, Naidu SS, Massaro JM, Kirtane AJ, Moses J, Magnus Ohman E, Džavík V, Palacios IF, Heldman AW, Popma JJ, O’Neill WW. Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study. Catheter Cardiovasc Interv. 2014 Jun 1;83(7):1057–1064.
Journal cover image

Published In

Catheter Cardiovasc Interv

DOI

EISSN

1522-726X

Publication Date

June 1, 2014

Volume

83

Issue

7

Start / End Page

1057 / 1064

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Prospective Studies
  • Plaque, Atherosclerotic
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Male
  • Incidence