| Background Coronary rotational atherectomy(RA)is an efficient treatment for complicated severe calcified lesions percutaneous coronary intervention.And RA is often used in calcified lesions percutaneous coronary intervention,but when the lesion length is larger than 25 mm or the low lesions distal blood flow is slow or patients suffer from frequent resting angina or severe left ventricular dysfunction,the doctor who use RA should be very vigilant,because the rate of some serious complications such as burr entrapment,transection of the guidewire and vascular perforation,et al will be higher than the patients who don not suffer these situation.In addition,there are some research reporting that when the lesion length is larger than 25 mm,though serious complications such as burr entrapment,transection of the guidewire and vascular perforation is extremely rare,a higher incidence of slow flow and periprocedural MI have a great relationship with diffuse long lesions(more than 25mm).Therefore,coronary lesion its length longer than 25 mm is a kind of relative contraindication.With the widespread application of rotational atherectomy and the operation skills innovations,though the ratio of slow flow and interventional operation events such as myocardial infarction in long lesion RA operations is lower,the reactions such as hypotension or tachycardia after RA are also very common.This phenomenon implies that the pathophysiology mechanisms which cause some complications such as slow flow and periprocedural MI still exist.In the past,some researches of our center had certified the immediateness safety and efficacy when RA was applied in the coronary lesion longer than 25 mm.But the long-term safety and efficacy of the patients who experience RA for the coronary lesion longer than 25 mm is unknown.Now the purpose of this research is to further certify the long-term safety and efficacy of the patients who experience RA for the coronary lesion longer than 25 mm by following up the clinical end points of these patients.In addition,this research will evaluate the long-term life quality of these patients to further specify the efficiency of the long lesion RA treatment.Objective The purpose of this study is to further certify the long-term safety and efficacy of the patients who experience RA for the coronary lesion longer than 25 mm.Methods A retrospective analysis in our center from October 2013 to August 2016 was carried out.The patients whose CAG were found in severe coronary artery calcification were analyzed,so 111 patients with coronary heart disease or PCI balloon cannot expand lesions treated with RA cases were composed in this research,then they,according to the final row RA coronary lesion length,divided into longer lesion group(LLG,lesions≥25 mm)and shorter lesion group(SLG,lesions < 25 mm).The number of patients in LLG is 58,while this number in SLG is 53.The follow-up date is mean 38±7.77 months,and then we compare the ratio of major adverse cardiac events during hospitalization(MACE)between two groups,and evacuating the life quality by the first portion of Seattle Angina Scale.All the data obtained were analyzed by SPSS23.0 statistical software.Results The study retrospectively analyzed 111 patients who accepted RA treatment for coronary heart disease from October 2013 to August 2016.In this time window,58 patients were divided in LLG,and 53 patients were divided in SLG.1.The number of patients who suffer from three branch lesions in SLG is 22(41.5%)while this number in LLG is 34(58.7%),and the p-value is 0.112,so there is no statistically significant difference.The most of the rotational target vessel in two groups were both LAD,and the number of SLG is 41(77.4%)which is comparable with this number in LLG[ 44(75.9%)],and the p value is 0.892.The average length of target lesions in LLG was 37.30±6.009 mm,the average length of lesions in SLG was 20.70±3.561 mm,p<0.01,and the two groups had statistically significant difference.2.The number of patients who accepted RA by arteria femoralis in SLG was 14(26.4%),but this number in LLG is 9(15.5%),and the p-value was 0.157),therefore there is no statistically significant difference.The external diameter of guiding catheter used in two groups were [6Fr:SLG 36(67.9%)vs.LLG 34(58.6%),7Fr:SLG 17(32.1%)vs.LLG 24(41.4%),p=0.310],so there is no statistically significant difference.The average stenosis degree of target vascular in SLG was 91.32±6.073%,and the degree in LLG was 91.88±5.783%,we can calculate the p-value was 0.621,therefore the two groups had no statistically significant difference.As for the average diameter of rotational burr,we analyze this by divide four kinds of sizes because some patients may be used more than one kind of size,but the results in figure 3 show that there is no significant difference between two groups.The number of patients who used one rotational burr in SLG is 45(84.9%),while this number for LLG is 44(75.9%),and the number of patients who used two rotational burr in SLG is 8(15.1%),while this number for LLG is 14(24.1%),and the p-value is 0.233,so the two groups had no statistically significant difference.The ratio of rotational burr comparing the diameter of target vascular was SLG 0.48±0.052 vs.LLG 0.48±0.055,p=0.960,and the two groups had no statistically significant difference.LLG preoperative TIMI blood flow classification was lower than SLG preoperative,the difference was statistically significant(SLG 2.34±0.898 vs.LLG 1.95±0.826,p=0.019).However,there was no significant difference after operation between the two groups in the TIMI classification(SLG 2.77±0.577 vs.LLG 2.84±0.523,p=0.498).Two groups of patients in the total length of stent implantation was statistically significant difference(SLG 31.57±8.586 mm vs.LLG 53.48±8.607,p<0.01).There was no significant difference between SLG and LLG in the use of temporary pacing(SLG 7(13.2%)vs.LLG 10(17.2%),p=0.556).There was no significant difference between the two groups in the dosage of contrast agent(SLG 170.75±26.808 ml vs.LLG 177.07±33.193 ml,p=0.275).3.After an average of 38 ± 7.77 months,the total mortality rate in SLG was 9.5%,and this rate in LLG was 8.6%,the p-value was 0.881,so the two groups had no statistically significant difference on this aspect.The ratio of MACE in two groups were(SLG 5(9.4%)vs.LLG 6(10.3%);HR=0.903[95%CI 0.259-3.151],P=0.873),and the two groups had no statistically significant difference.The number of cardiac death in two groups were(SLG 2(3.8%)vs.LLG 1(1.7%),p=0.937),and the two groups had no statistically significant difference.The number of target lesion revascularization in two groups were(SLG 3(5.7%)vs.LLG 2(3.4%),P=0.918),and the two groups had no statistically significant difference.The number of new stroke after RA in two groups were(SLG 1(1.9%)vs.LLG 3(5.2%),P=0.676),and the two groups had no statistically significant difference.The score of Seattle Angina Scale in two groups were(SLG 39.77±6.166 vs.LLG 40.79±4.400,P=0.315),and the two groups had no statistically significant difference.Conclusion AS for the lesions which are longer than 25 mm,Percutaneous coronary rotational atherectomy,for long-term,is also safe and effective. |
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