Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support

Autor: Deepak Kapoor, Supawat Ratanapo, Arun Nagabandi, Hoyle Whiteside
Rok vydání: 2018
Předmět:
Atherectomy
Coronary
Male
medicine.medical_specialty
Time Factors
Percutaneous
medicine.medical_treatment
Myocardial Infarction
Hemodynamics
Subgroup analysis
Coronary Artery Disease
030204 cardiovascular system & hematology
Risk Assessment
Severity of Illness Index
Ventricular Function
Left
Ventricular Dysfunction
Left
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Statistical significance
Internal medicine
medicine
Humans
Hospital Mortality
cardiovascular diseases
030212 general & internal medicine
Acute Coronary Syndrome
Aged
Retrospective Studies
Aged
80 and over
Ejection fraction
business.industry
Percutaneous coronary intervention
General Medicine
Middle Aged
Treatment Outcome
Conventional PCI
cardiovascular system
Cardiology
Female
Stents
Hypotension
Cardiology and Cardiovascular Medicine
business
Mace
Zdroj: Cardiovascular Revascularization Medicine. 19:660-665
ISSN: 1553-8389
DOI: 10.1016/j.carrev.2018.02.008
Popis: Introduction Elective insertion of a percutaneous circulatory assist device (PCAD) in high-risk patients is considered a reasonable adjunct to percutaneous coronary intervention (PCI). There is limited data examining the safety and efficacy of rotational atherectomy (RA) without hemodynamic support in patients with reduced left ventricular ejection fraction (LVEF). Methods We retrospectively identified 131 consecutive patients undergoing RA without elective PCAD over a three-year period. Patients were categorized into three groups: LVEF ≤30%, LVEF 31–50%, and LVEF >50%. The incidence of procedural hypotension, major adverse cardiac events (MACE), and mortality were recorded. Results Statistical analysis included 18, 42, and 71 patients with LVEF ≤30%, 31–50%, and >50%, respectively. Bailout hemodynamic support was required in four cases. Analysis revealed a significant trend as bailout hemodynamic support was required in 11.1% vs 2.4% (P = 0.1551) in the ≤30% vs 31–50% and 11.1% vs 1.4% (P = 0.0416) in the ≤30% vs >50% subgroups. Combined subgroup analysis also demonstrated statistical significance 11.1% vs 1.8% (P = 0.0324) in the ≤30% vs >30% subgroups. No-reflow phenomenon was more prevalent in patients with reduced LVEF (LVEF ≤30%: 11.1%, LVEF 31–50%: 2.4%, LVEF >50%: 0%; P = 0.0190). Otherwise, no significant differences in in-hospital MACE, or mortality were observed. Conclusion RA can be effectively utilized in patients with severely reduced LVEF; however, these patients are at increased risk of prolonged procedural hypotension requiring bailout hemodynamic support. If indicated, prompt implementation of hemodynamic support mitigated any impact of procedural hypotension on in-hospital MACE and mortality.
Databáze: OpenAIRE
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