Outcomes after Successful Percutaneous Coronary Intervention of Calcified Lesions Using Rotational Atherectomy, Cutting-Balloon Angioplasty, or Balloon-Only Angioplasty before Drug-Eluting Stent Implantation

Björn Redfors, Akiko Maehara, Bernhard Witzenbichler, Giora Weisz, Thomas D. Stuckey, Timothy D. Henry, Thomas McAndrew, Roxana Mehran, Ajay J. Kirtane, Gregg W. Stone, Philippe Genereux

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES: To report adverse event rates after rotational atherectomy (RA) with contemporary drug-eluting stent (DES) implantation and compare RA to cutting balloon (CB) angioplasty and balloon-only angioplasty (BA) in the all-comers ADAPT-DES trial. BACKGROUND: Percutaneous coronary intervention (PCI) of calcified lesions is increasingly common and is associated with a high risk of adverse events. RA can ablate calcified plaque and facilitate stent delivery; however, in conjunction with first-generation DES, RA was not superior to BA alone in regard to adverse events. METHODS: ADAPT-DES enrolled 8582 patients who underwent successful PCI with DES, of whom 2644 had calcified target lesions and were included in this study. Among these patients, 1610 had exclusively second-generation DESs implanted. We present Kaplan-Meier rates for the primary endpoint of target-vessel failure (TVF; defined as death, myocardial infarction, or target-vessel revascularization) as well as its components, for patients who had RA, CB, or BA. RESULTS: Among the 2644 patients, RA and CB were used in 150 patients (5.7%) and 53 patients (2.0%), respectively. TVF occurred in 20.8% of the RA patients, 24.1% of the CB patients, and 17.9% of the BA patients over the 2-year study period (P≤.41) and was primarily driven by target-vessel revascularization (13.8%, 11.4%, and 10.2%, respectively). RA patients with acute coronary syndromes had nominally higher 2-year TVF rates than RA patients with stable coronary artery disease. CONCLUSION: TVF is common after contemporary DES-PCI of calcified lesions, independent of the technique used to prepare the vessel for stent implantation. Better treatment strategies are needed.

Original languageEnglish (US)
Pages (from-to)378-386
Number of pages9
JournalJournal of Invasive Cardiology
Volume29
Issue number11
StatePublished - Nov 1 2017
Externally publishedYes

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Coronary Atherectomy
Drug-Eluting Stents
Balloon Angioplasty
Percutaneous Coronary Intervention
Stents
Acute Coronary Syndrome
Coronary Artery Disease

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Redfors, Björn ; Maehara, Akiko ; Witzenbichler, Bernhard ; Weisz, Giora ; Stuckey, Thomas D. ; Henry, Timothy D. ; McAndrew, Thomas ; Mehran, Roxana ; Kirtane, Ajay J. ; Stone, Gregg W. ; Genereux, Philippe. / Outcomes after Successful Percutaneous Coronary Intervention of Calcified Lesions Using Rotational Atherectomy, Cutting-Balloon Angioplasty, or Balloon-Only Angioplasty before Drug-Eluting Stent Implantation. In: Journal of Invasive Cardiology. 2017 ; Vol. 29, No. 11. pp. 378-386.
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title = "Outcomes after Successful Percutaneous Coronary Intervention of Calcified Lesions Using Rotational Atherectomy, Cutting-Balloon Angioplasty, or Balloon-Only Angioplasty before Drug-Eluting Stent Implantation",
abstract = "OBJECTIVES: To report adverse event rates after rotational atherectomy (RA) with contemporary drug-eluting stent (DES) implantation and compare RA to cutting balloon (CB) angioplasty and balloon-only angioplasty (BA) in the all-comers ADAPT-DES trial. BACKGROUND: Percutaneous coronary intervention (PCI) of calcified lesions is increasingly common and is associated with a high risk of adverse events. RA can ablate calcified plaque and facilitate stent delivery; however, in conjunction with first-generation DES, RA was not superior to BA alone in regard to adverse events. METHODS: ADAPT-DES enrolled 8582 patients who underwent successful PCI with DES, of whom 2644 had calcified target lesions and were included in this study. Among these patients, 1610 had exclusively second-generation DESs implanted. We present Kaplan-Meier rates for the primary endpoint of target-vessel failure (TVF; defined as death, myocardial infarction, or target-vessel revascularization) as well as its components, for patients who had RA, CB, or BA. RESULTS: Among the 2644 patients, RA and CB were used in 150 patients (5.7{\%}) and 53 patients (2.0{\%}), respectively. TVF occurred in 20.8{\%} of the RA patients, 24.1{\%} of the CB patients, and 17.9{\%} of the BA patients over the 2-year study period (P≤.41) and was primarily driven by target-vessel revascularization (13.8{\%}, 11.4{\%}, and 10.2{\%}, respectively). RA patients with acute coronary syndromes had nominally higher 2-year TVF rates than RA patients with stable coronary artery disease. CONCLUSION: TVF is common after contemporary DES-PCI of calcified lesions, independent of the technique used to prepare the vessel for stent implantation. Better treatment strategies are needed.",
author = "Bj{\"o}rn Redfors and Akiko Maehara and Bernhard Witzenbichler and Giora Weisz and Stuckey, {Thomas D.} and Henry, {Timothy D.} and Thomas McAndrew and Roxana Mehran and Kirtane, {Ajay J.} and Stone, {Gregg W.} and Philippe Genereux",
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Outcomes after Successful Percutaneous Coronary Intervention of Calcified Lesions Using Rotational Atherectomy, Cutting-Balloon Angioplasty, or Balloon-Only Angioplasty before Drug-Eluting Stent Implantation. / Redfors, Björn; Maehara, Akiko; Witzenbichler, Bernhard; Weisz, Giora; Stuckey, Thomas D.; Henry, Timothy D.; McAndrew, Thomas; Mehran, Roxana; Kirtane, Ajay J.; Stone, Gregg W.; Genereux, Philippe.

In: Journal of Invasive Cardiology, Vol. 29, No. 11, 01.11.2017, p. 378-386.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes after Successful Percutaneous Coronary Intervention of Calcified Lesions Using Rotational Atherectomy, Cutting-Balloon Angioplasty, or Balloon-Only Angioplasty before Drug-Eluting Stent Implantation

AU - Redfors, Björn

AU - Maehara, Akiko

AU - Witzenbichler, Bernhard

AU - Weisz, Giora

AU - Stuckey, Thomas D.

AU - Henry, Timothy D.

AU - McAndrew, Thomas

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

AU - Genereux, Philippe

PY - 2017/11/1

Y1 - 2017/11/1

N2 - OBJECTIVES: To report adverse event rates after rotational atherectomy (RA) with contemporary drug-eluting stent (DES) implantation and compare RA to cutting balloon (CB) angioplasty and balloon-only angioplasty (BA) in the all-comers ADAPT-DES trial. BACKGROUND: Percutaneous coronary intervention (PCI) of calcified lesions is increasingly common and is associated with a high risk of adverse events. RA can ablate calcified plaque and facilitate stent delivery; however, in conjunction with first-generation DES, RA was not superior to BA alone in regard to adverse events. METHODS: ADAPT-DES enrolled 8582 patients who underwent successful PCI with DES, of whom 2644 had calcified target lesions and were included in this study. Among these patients, 1610 had exclusively second-generation DESs implanted. We present Kaplan-Meier rates for the primary endpoint of target-vessel failure (TVF; defined as death, myocardial infarction, or target-vessel revascularization) as well as its components, for patients who had RA, CB, or BA. RESULTS: Among the 2644 patients, RA and CB were used in 150 patients (5.7%) and 53 patients (2.0%), respectively. TVF occurred in 20.8% of the RA patients, 24.1% of the CB patients, and 17.9% of the BA patients over the 2-year study period (P≤.41) and was primarily driven by target-vessel revascularization (13.8%, 11.4%, and 10.2%, respectively). RA patients with acute coronary syndromes had nominally higher 2-year TVF rates than RA patients with stable coronary artery disease. CONCLUSION: TVF is common after contemporary DES-PCI of calcified lesions, independent of the technique used to prepare the vessel for stent implantation. Better treatment strategies are needed.

AB - OBJECTIVES: To report adverse event rates after rotational atherectomy (RA) with contemporary drug-eluting stent (DES) implantation and compare RA to cutting balloon (CB) angioplasty and balloon-only angioplasty (BA) in the all-comers ADAPT-DES trial. BACKGROUND: Percutaneous coronary intervention (PCI) of calcified lesions is increasingly common and is associated with a high risk of adverse events. RA can ablate calcified plaque and facilitate stent delivery; however, in conjunction with first-generation DES, RA was not superior to BA alone in regard to adverse events. METHODS: ADAPT-DES enrolled 8582 patients who underwent successful PCI with DES, of whom 2644 had calcified target lesions and were included in this study. Among these patients, 1610 had exclusively second-generation DESs implanted. We present Kaplan-Meier rates for the primary endpoint of target-vessel failure (TVF; defined as death, myocardial infarction, or target-vessel revascularization) as well as its components, for patients who had RA, CB, or BA. RESULTS: Among the 2644 patients, RA and CB were used in 150 patients (5.7%) and 53 patients (2.0%), respectively. TVF occurred in 20.8% of the RA patients, 24.1% of the CB patients, and 17.9% of the BA patients over the 2-year study period (P≤.41) and was primarily driven by target-vessel revascularization (13.8%, 11.4%, and 10.2%, respectively). RA patients with acute coronary syndromes had nominally higher 2-year TVF rates than RA patients with stable coronary artery disease. CONCLUSION: TVF is common after contemporary DES-PCI of calcified lesions, independent of the technique used to prepare the vessel for stent implantation. Better treatment strategies are needed.

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M3 - Article

VL - 29

SP - 378

EP - 386

JO - Journal of Invasive Cardiology

JF - Journal of Invasive Cardiology

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