YAMAGUCHI JUNICHI    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor and Division head
Language	English
Title	Predictors for long-term cardiovascular death after rotational atherectomy in patients with regular hemodialysis - from J2T multicenter registry -
Conference	ESC CONGRESS 2017
Promoters	European Society of Cardiology
Conference Type	International society and overseas society
Presentation Type	Poster notice
Lecture Type	General
Publisher and common publisher	JUJO Kentaro, OTSUKI Hisao, ◎TANAKA Kazuki, I.Okai, M.Nakashima, T.Dohi, S.Okazaki, H.Kawashima, Y.Nara, H.Kyono, YAMAGUCHI Junichi, K.Miyauchi, H.Daida, K.Kozuma, HAGIWARA Nobuhisa
Date	2017/08/29
Venue (city and name of the country)	Barcelona, SPAIN
Summary	Background: Patients with regular hemodialysis (HD) frequently have a heavy calcium in the stenotic coronary arteries, and show poorer prognosis after percutaneous coronary intervention (PCI) than those without HD. Rotational atherectomy (RA) is one of the strategic options for technical success of PCI in the severely calcified lesion. Purpose: We aimed to identify clinical and procedural features predicting long-term clinical prognosis of HD patients after PCI with RA in the drug-eluting stent (DES) era. Methods: This study included 1,134 consecutive patients who underwent PCI with RA at three university hospitals between 2004 and 2014. Among them, 316 patients on regular HD were ultimately analyzed. The primary endpoint of this study was cardiovascular (CV) death. Results: The study population was typically middle age (65 years-old), and 81% male with a normal BMI (23 kg/m2) and diverse comorbidities, including 66% diabetes, 31% insulin use, 57% dyslipidemia and 45% prior revascularization therapy. At the time of PCI, bare metal stents were implanted only in 10% of the study population, and 1st generation DES in 49%. During 1,105 days of median observational period, CV death was observed in 19% (60 patients) of the study population. Cox regression analysis revealed that the step-up of ablation burr size and final TIMI 3 flow were independent predictors for CV death as well as brain natriuretic peptide (BNP), triglyceride, and oral medications (Table). Conclusion: In the DES era, optimal medication and sufficient ablation of calcium should be considered for HD patients who were treated with RA against severe calcified coronary artery stenosis, in order to improve long-term CV mortality.