Impact of Calcified Lesion Complexity on the Success of Percutaneous Coronary Intervention With Upfront High-Speed Rotational Atherectomy or Modified Balloons - A Subgroup-Analysis From the Randomized PREPARE-CALC Trial.
Angioplasty, Balloon, Coronary
Atherectomy, Coronary
/ adverse effects
Coronary Angiography
Coronary Artery Disease
/ diagnostic imaging
Drug-Eluting Stents
Humans
Percutaneous Coronary Intervention
/ adverse effects
Retrospective Studies
Treatment Outcome
Vascular Calcification
/ diagnostic imaging
Calcified lesion
Complex coronary lesion
Lesion preparation
Type-C lesion
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
19
11
2020
revised:
04
01
2021
accepted:
05
01
2021
pubmed:
17
1
2021
medline:
1
1
2022
entrez:
16
1
2021
Statut:
ppublish
Résumé
In the randomized PREPARE-CALC trial, lesion preparation of calcified lesions with upfront rotational atherectomy (RA) prior to drug-eluting stent (DES) implantation resulted in higher acute success as compared to a provisional modified balloon (MB) strategy. We aimed to investigate the impact of calcified lesion complexity on the treatment effect with either MB or RA. Two hundred patients were randomized to lesion preparation with either MB or RA. The study population was stratified according to lesion complexity into at least one type-C lesion or into exclusively non-type-C lesions. Endpoints were strategy success, need for bail-out RA, acute lumen gain, and late lumen loss (LLL) at 9 months. In total, 143 patients were graded as type-C (45% patients were allocated to MB), whereas 57 patients were graded as non-type-C (61% patients were allocated to MB). In patients with at least one type-C lesion, strategy success with RA was higher than with MB (97% vs 72%, p < 0.001), but superiority of RA was not observed in patients with non-type-C lesions (100% vs 97%, p = 1.00; p In patients with calcified non-type-C lesions, the treatment strategy with RA or MB before DES implantation results in comparable success rates, whereas in type-C lesions upfront RA appears to be the superior upfront strategy.
Sections du résumé
BACKGROUND/PURPOSE
In the randomized PREPARE-CALC trial, lesion preparation of calcified lesions with upfront rotational atherectomy (RA) prior to drug-eluting stent (DES) implantation resulted in higher acute success as compared to a provisional modified balloon (MB) strategy. We aimed to investigate the impact of calcified lesion complexity on the treatment effect with either MB or RA.
METHODS/MATERIALS
Two hundred patients were randomized to lesion preparation with either MB or RA. The study population was stratified according to lesion complexity into at least one type-C lesion or into exclusively non-type-C lesions. Endpoints were strategy success, need for bail-out RA, acute lumen gain, and late lumen loss (LLL) at 9 months.
RESULTS
In total, 143 patients were graded as type-C (45% patients were allocated to MB), whereas 57 patients were graded as non-type-C (61% patients were allocated to MB). In patients with at least one type-C lesion, strategy success with RA was higher than with MB (97% vs 72%, p < 0.001), but superiority of RA was not observed in patients with non-type-C lesions (100% vs 97%, p = 1.00; p
CONCLUSIONS
In patients with calcified non-type-C lesions, the treatment strategy with RA or MB before DES implantation results in comparable success rates, whereas in type-C lesions upfront RA appears to be the superior upfront strategy.
Identifiants
pubmed: 33451925
pii: S1553-8389(21)00005-1
doi: 10.1016/j.carrev.2021.01.002
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
26-31Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Dr. Hemetsberger reports speaker's honoraria from Boston Scientific. Drs. Toelg and Richardt report speaker's honoraria from Boston Scientific, Abbott Vascular, and Biotronik. Dr. Byrne reports Research funding to the institution of prior employment from Celonova Biosciences. Dr. Allali reports being a proctor for Boston Scientific. The other authors report no conflicts of interest.