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||Long-Term Prognosis of Patient Requiring the Mechanical Circulatory Support During Percutaneous Coronary Intervention With Rotational Atherectomy: Sub-Analysis From J2T-ROTA Registry|
|会議名||American Heart Association (AHA) Scientific Sessions 2018|
|主催者||American Heart Association (AHA)|
|発表者・共同発表者||◎TANAKA Kazuki, JUJO Kentaro, OOTSUKI Hisao, OKAI Iwao, NAKASHIMA Makoto, Dohi Tomotaka, OKAZAKI Shinya, KAWASHIMA Hideyuki, NARA Yugo, KYONO Hiroyuki, ARASHI Hiroyuki, MIYAUCHI Katsumi, YAMAGUCHI Junichi, DAIDA Hiroyuki, KOZUMA Ken, HAGIWARA Nobuhisa|
|学会抄録||Circulation 138(Supple 1),Abstract 11662 2018|
|概要||Session Title: Outcomes and Disparities in Interventional Cardiology
Introduction: Rotational atherectomy (RA) is the strategic options for technical success of percutaneous coronary intervention (PCI) in severely calcified lesions. However, even in the drug-eluting stent (DES) era, we sometimes experience slow-flow or no-reflow phenomenon following RA, and further need mechanical circulatory support (MCS) including intra-aortic balloon pumping (IABP) and percutaneous cardio-pulmonary support (PCPS) to restore hemodynamic instability.
Hypothesis: MCS during PCI with RA is thought to be related to poorer prognosis. We aimed to clarify the clinical prognosis of the patients who were performed RA with or without MCS in the DES era, and identify preoperative features requiring MCS during PCI with RA.
Methods: We evaluated data from the J2T-ROTA registry that included 1,090 patients with heavily calcified de novo coronary artery stenosis who underwent PCI with RA at three university hospitals between 2004 and 2014. Patients were divided into 2 groups depending on MCS use, and clinical and angiographic parameters were retrospectively compared between the groups. The primary endpoint was all-cause mortality.
Results: Among the enrolled patients, 29 patients (2.6%) have been started MCS during the PCI. MCS group consists of significantly older patients than Non-MCS group (73.3 vs. 69.7 years, p=0.035), with higher prevalence of diabetes (79% vs. 59%, p=0.034) and higher levels of brain natriuretic peptide (1,267 vs. 430 pg/mL, p=0.039) and lower left ventricular ejection fraction (44.0% vs. 55.3%: p<0.001). MCS group also included patients with presentation of acute coronary syndrome (48% vs. 14%: p<0.001), and those with target lesion in the left anterior descending artery (86% and 67%, p=0.022). Kaplan-Meier analysis showed that all-cause mortality was significantly higher in the MCS group (median follow-up 1,105 days) (at 1-year: 50.0% vs. 6.1%, log-rank test: p<0.001). With multivariate Cox proportional hazards analysis, MCS had a potent association with all-cause mortality (HR: 2.61 [95% CI: 1.24-5.48]), even after the adjustment of diverse covariants.
Conclusions: MCS during PCI with RA was strongly related to all-cause mortality, and patients who needed MCS had severer clinical and procedural features.