篇名 | Rotablation for Octogenarians in a Modern Cathlab: Short- and Intermediate-Term Results |
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卷期 | 39:3 |
作者 | Yu-Chen Hu 、 Wei-Jhong Chen 、 Chih-Hung Lai 、 Yu-Wei Chen 、 Chieh-Shou Su 、 Wei-Chun Chang 、 Chi-Yan Wang 、 Tsun-Jui Liu 、 Kae-Woei Liang 、 Wen-Lieng Lee |
頁次 | 424-434 |
關鍵字 | Complex and high-risk indicated procedure 、 Coronary artery disease 、 Octogenarians 、 Rotational atherectomy 、 Very elderly 、 MEDLINE 、 Scopus 、 SCIE |
出刊日期 | 202305 |
DOI | 10.6515/ACS.202305_39(3).20220926B |
Background: There are limited reports on the treatment of complex calcified lesions using rotational atherectomy (RA) in octogenarians, particularly in high-risk patients. Objective: To evaluate procedural and clinical outcomes of RA in octogenarians. Methods: Consecutive RA patients from2010 to 2018were selected from our catheterization laboratory database, stratified into two groups (≧ or < 80 years old), and analyzed. Results: A total of 411 patients (269 males and 142 females) with a mean age of 73.8 ± 11.3 years were enrolled, of whom 153 were ≧ 80 years old and 258 were < 80 years old. Most of the patients displayed high-risk features. The baseline Syntax scores were high in both groups, and most lesions were heavily calcified (96.1% vs. 97.3%, p = 0.969, respectively). The use of hemodynamic support intra-aortic balloon pump was more frequent in the octogenarians (21.6% vs. 11.6%, p = 0.007), but the RA completion rate was similarly high (95.9% vs. 99.1%, p = 0.842). There was no difference in acute complications. The total/cardiovascular (CV) death rate within one year was higher in the octogenarians, along with higher major adverse cardiovascular event (MACE)/CV MACE rates in the first month. Cox regression analysis showed that age ≧ 80 years, acute coronary syndrome, ischemic cardiomyopathy/shock, multi-vessel disease and serum creatinine were all predictors of MACE, and that these factors plus peripheral artery disease were predictors of all-cause mortality in these patients. Conclusions: RA is feasible with a very high success rate in high-risk octogenarians with complex anatomies, and with equal safety and no increase in complications. The higher rates of all-cause death and MACE were attributed to an older age and other traditional risk factors.