所属 医学部 医学科（東京女子医科大学病院） 職種 特任教授
|発表タイトル||Prediction of 3-year mortality after rotational atherectomy in severely calcified coronary artery|
|会議名||ESC CONGRESS 2017|
|主催者||European Society of Cardiology|
|発表者・共同発表者||JUJO Kentaro, TANAKA Kazuki, ◎OTSUKI Hisao, I.Okai, M.Nakashima, T.Dohi, S.Okazaki, H.Kawashima, Y.Nara, H.Kyono, YAMAGUCHI Junichi, K.Miyauchi, H.Daida, K.Kozuma, HAGIWARA Nobuhisa|
|概要||Background: Rotational atherectomy (RA) is one of the strategic options for technical success of percutaneous coronary intervention (PCI) to the severely calcified lesion. However, long-term clinical prognosis after PCI with RA has not been fully discussed in the drug-eluting stent (DES) era.
Purpose: The purpose of this study was to identify clinical and procedural features predicting long-term clinical prognosis after PCI with RA.
Methods: This study initially included 404 consecutive patients who underwent PCI with RA between 2004 and 2013. Among them, 315 patients who were followed at least 3 years after PCI were retrospectively analyzed for death from all causes. Cox regression analyses were performed to assess the associations between patient characteristics and 3-year mortality.
Results: There were 72 deaths over the 3-year follow-up (cumulative risk, 23%), of which 35 were within the first year. The univariate predictors of mortality included age, body mass index (BMI), acute coronary syndrome (ACS), renal insufficiency, diabetes and left ventricular ejection fraction (LVEF), lab data including brain natriuretic peptide (BNP), C-reactive protein (CRP), triglyceride, and statin treatment at the time of PCI, and final TIMI 3 coronary blood flow. Five variables selected from the initial multivariate model were weighted proportionally to their respective odds ratio for 3-year mortality (age >80 years [1 points], ACS [2 points], baseline LVEF <40% [2 points], final TIMI flow <3 [4 points], and lack of statin treatment at the time of PCI [3 points]). Three strata of risk were defined; low risk, score 0 to 1; mild risk, score 2 to 3; moderate risk, score 4 to 5 and high risk, score ≥6. Positive correlation between 3-year mortality and risk scores of those predictors was observed (p<0.001, Figure 1). Risk score ≥2 had 65.4% sensitivity and 99.1% specificity for predicting 3-year mortality. Kaplan-Meier analysis validated this risk stratification (Log-rank test: p<0.001, Figure 2).
Conclusion: In the DES era, risk scores by specific clinical characteristics at baseline predicted 3-year mortality, and may be useful for long-term risk stratification of patients undergoing PCI with rotational atherectomy.