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ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 11 - 2024 |
doi: 10.3389/fcvm.2024.1451229
Comparison of patients undergoing protected high risk percutaneous coronary intervention using either intravascular lithotripsy or rotational atherectomy
Provisionally accepted- Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
Background: Treating heavily calcified vessels is a challenging task in patients with an impaired left ventricular ejection fraction (LVEF). Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients in high-risk PCI (HRPCI). In this retrospective registry, we investigated 25 patients undergoing a protected HRPCI receiving either intravascular lithotripsy (IVL+pMCS; n=11) or rotational atherectomy (RA+pMCS; n=14). Primary Endpoint was defined as periinterventional hemodynamic stability. Secondary endpoint was defined as major adverse cardiac events (MACE). Results: Patients in the IVL+pMCS group had a significantly higher mean arterial pressure (MAP) at the end of the procedure (p=0.04). However, the ∆-change in MAP was not significant (-12mmHg (±20.3) vs. -16.1mmHg (±23.9) p=0.709). The proportion of patients requiring postinterventional catecholamines was significantly lower in the IVL+pMCS group (p=0.02). The ∆ change in Syntax Score were not significant between groups (IVL+pMCS -22 (±5.8) vs.RA+pMCS -21.2 (±7.6), p=0.783). MACE did occur less in the group of IVL+pMCS (0% vs. 20%, p=0.046). Cox regression analysis revealed that pMCS insertion as a bailout strategy (p=0.001) and the occurrence of slow-reflow were associated with a higher risk for in-hospital death (p=0.021). Conclusions: In our cohort patients in the IVL+pMCS group were hemodynamical more stable which led to a lower rate of catecholamine usage. pMCS as a bailout strategy and the occurrence of the slowreflow phenomenon were associated with in-hospital death.
Keywords: High-risk PCI, Percutaneous mechanical circulatory support, Rotablation, intravascular lithotripsy, slow reflow
Received: 18 Jun 2024; Accepted: 24 Oct 2024.
Copyright: © 2024 Krause, Afzal, Gjata, Lindner, Saad, Steinbach, Zayat, Haneya, Werner and Leick. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Juergen Leick, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
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