所属 医学部 医学科（東京女子医科大学病院） 職種 助教
|発表タイトル||ロータブレーターを用いた経皮的冠動脈形成術の際に機械的循環補助を要した症例の長期予後に関する検討 J2T-ROTAregistry サブ解析|
|発表者・共同発表者||◎田中一樹, 重城健太郎, 大槻尚男, 岡井巌, 中島真, 土肥智貴, 岡崎真也, 川嶋秀幸, 奈良有悟, 興野寛幸, 嵐弘之, 山口淳一, 宮内克己, 代田浩之, 上妻謙, 萩原誠久|
|概要||Background: Rotational atherectomy (RA) is the strategic option for percutaneous coronary intervention (PCI). However, in patients undergoing RA, we sometimes experience slow-flow/no-reflow phenomenon that requires the mechanical circulatory support (MCS). We aimed to clarify the long-term prognosis of patients requiring MCS during PCI with RA.
Methods: We evaluated data from J2T-ROTA registry including 1,090 patients with heavily calcified coronary stenoses who underwent PCI using RA at three hospitals between 2004 and 2014. Patients were divided into 2 groups depending on MCS use, and the primary endpoint was allcause mortality.Results: Among patients enrolled, 29 patients (2.6%) needed MCS. Patients in MCS group were significantly older (73.3 vs. 69.7 years, p=0.035), and had higher levels of brain natriuretic peptide (BNP) (1,267 vs. 430 pg/mL, p=0.039) and lower left ventricular ejection fraction (LVEF) (44.0% vs. 55.3%, p<0.001) than Non-MCS group. MCS group also included patients with presentation of acute coronary syndrome (48% vs. 14%: p<0.001) and left anterior descending (LAD) lesion (86% vs. 67%, p=0.022). Kaplan-Meier analysis with 1,105 days of median observation period showed that all-cause mortality was significantly higher in MCS group (at 1-year: 50.0% vs. 6.1%, Log-rank: p<0.001). With multivariate analysis, MCS had a potent association with all-cause mortality (hazard ratio: 2.61 [95% confidence interval: 1.24-5.48]).
Conclusion: MCS use during PCI with RA was strongly related to all-cause mortality.