Table_5_Safety and Feasibility of Rotational Atherectomy for Retrograde Recanalization of Chronically Occluded Coronary Arteries.docx

ObjectiveTo evaluate the safety and feasibility of rotational atherectomy (RA) in retrograde chronic total occlusion percutaneous coronary intervention (CTO-PCI) by analyzing immediate and long-term outcomes.
BackgroundRecent evidence supports the safety and feasibility of RA in CTO-PCI. However, few studies have focused on the use of RA in a retrograde approach to percutaneous revascularization of chronic total occlusion (CTO) lesions and information on long-term outcomes is lacking.
MethodsA total of 329 patients who underwent retrograde CTO-PCI, out of 1496 consecutive CTO-PCI patients from April 2017 to July 2020, were retrospectively recruited from the 2nd Cardiology Department of the Guangdong Provincial People's Hospital. 16 patients underwent RA (RA group) whilst 313 did not (non-RA group).
ResultsTechnical (87.5% vs. 87.5) and procedural (85.9% vs. 87.5) success rates were similar between both groups. There was no difference concerning major procedural complications between groups (12.5% vs. 19.2%; p > 0.75). No in-hospital MACCEs was recorded in the RA group while there were eight MACCEs in the non-RA group (p > 0.99). In the RA group, 2 cases recorded perforation (1 target vessel perforation case and 1 branch vessel perforation), and 55 cases of vessel perforations/dissections were recorded in non-RA group including 18 target vessel perforations, 2 branch vessel perforations, 35 collateral vessel perforations (one patient died from cardiac tamponade). No difference was found in terms of the perforation rate between the two groups (p > 0.99). Over a mean follow-up period of 26.47 ± 14.46 months, use of RA in retrograde CTO-PCI did not result in an increased mortality rate [hazard ratio (HR) 1.58, 95% confidence interval (CI), 0.31–8.21, p = 0.65], major adverse cardiac and cerebral events (HR 0.99, 95% CI 0.35–2.79, p = 0.99) or overall rehospitalization rate (HR 1.27, 95% CI 0.44–3.67, p = 0.67). Adjusted Kaplan–Meier curves according to Cox regression model suggested several predictors influencing the all-cause mortality, cardiovascular mortality, MACCEs, stroke rate, non-fatal myocardial infarction, target vessel recanalization rate and rehospitalization rate in the comparison.
ConclusionsOur study demonstrates that the in-hospital outcomes and long-term follow up events were the same between RA and non-RA retrograde CTO-PCI patients. RA offered an option for skillful operators in difficult cases when the lesion was severely calcified in retrograde CTO-PCI.

**研究目的**：通过分析即刻及长期结局，评估旋转斑块切除术（rotational atherectomy，RA）应用于逆行慢性完全闭塞经皮冠状动脉介入治疗（retrograde chronic total occlusion percutaneous coronary intervention，CTO-PCI）的安全性与可行性。
**研究背景**：现有证据支持RA应用于CTO-PCI的安全性与可行性，但目前鲜有研究聚焦于RA在慢性完全闭塞（chronic total occlusion，CTO）病变逆行经皮血运重建中的应用，且长期结局相关数据匮乏。
**研究方法**：本研究从广东省人民医院心内科二区回顾性纳入2017年4月至2020年7月期间收治的1496例连续CTO-PCI患者中的329例行逆行CTO-PCI的患者，其中16例接受RA治疗（RA组），剩余313例未接受RA治疗（非RA组）。
**研究结果**：两组的技术成功率（87.5% vs. 87.5%）与操作成功率（85.9% vs. 87.5%）均无显著差异。两组主要操作并发症发生率无统计学差异（12.5% vs. 19.2%；p > 0.75）。RA组未记录院内主要不良心脑血管事件（major adverse cardiac and cerebral events，MACCE），而非RA组共发生8例MACCE（p > 0.99）。RA组共出现2例血管穿孔（1例靶血管穿孔、1例分支血管穿孔）；非RA组共记录55例血管穿孔/夹层，其中18例靶血管穿孔、2例分支血管穿孔、35例侧支血管穿孔（1例患者因心脏压塞死亡）。两组穿孔率无统计学差异（p > 0.99）。平均随访时长为26.47±14.46个月，逆行CTO-PCI中使用RA并未增加死亡率[风险比（hazard ratio，HR）=1.58，95%置信区间（confidence interval，CI）：0.31~8.21，p=0.65]、主要不良心脑血管事件（HR=0.99，95%CI：0.35~2.79，p=0.99）或总体再住院率（HR=1.27，95%CI：0.44~3.67，p=0.67）。基于Cox回归模型校正后的Kaplan-Meier曲线显示，本研究中多项因素可影响全因死亡率、心血管死亡率、MACCE、卒中发生率、非致命性心肌梗死、靶血管再通率及再住院率。
**研究结论**：本研究表明，逆行CTO-PCI患者中，RA组与非RA组的院内结局及长期随访事件无显著差异。对于逆行CTO-PCI中病变严重钙化的复杂病例，RA可为熟练术者提供一种可行的治疗选择。