1. Impact of Calcified Lesion Complexity on the Success of Percutaneous Coronary Intervention With Upfront High-Speed Rotational Atherectomy or Modified Balloons - A Subgroup-Analysis From the Randomized PREPARE-CALC Trial
- Author
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Nader Mankerious, Mohamed El-Mawardy, Dmitriy S. Sulimov, Abdelhakim Allali, Gert Richardt, Adnan Kastrati, Derek R. Robinson, Hussain Traboulsi, Mohamed Abdel-Wahab, Ralph Toelg, Robert A. Byrne, and Rayyan Hemetsberger
- Subjects
Atherectomy, Coronary ,medicine.medical_specialty ,medicine.medical_treatment ,Lumen (anatomy) ,Subgroup analysis ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Balloon ,Lesion ,Calcified lesion ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Vascular Calcification ,High speed rotational atherectomy ,Retrospective Studies ,business.industry ,Percutaneous coronary intervention ,Stent ,Drug-Eluting Stents ,General Medicine ,Treatment Outcome ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
In the randomized PREPARE-CALC trial, lesion preparation of calcified lesions with upfront rotational atherectomy (RA) prior to drug-eluting stent (DES) implantation resulted in higher acute success as compared to a provisional modified balloon (MB) strategy. We aimed to investigate the impact of calcified lesion complexity on the treatment effect with either MB or RA.Two hundred patients were randomized to lesion preparation with either MB or RA. The study population was stratified according to lesion complexity into at least one type-C lesion or into exclusively non-type-C lesions. Endpoints were strategy success, need for bail-out RA, acute lumen gain, and late lumen loss (LLL) at 9 months.In total, 143 patients were graded as type-C (45% patients were allocated to MB), whereas 57 patients were graded as non-type-C (61% patients were allocated to MB). In patients with at least one type-C lesion, strategy success with RA was higher than with MB (97% vs 72%, p 0.001), but superiority of RA was not observed in patients with non-type-C lesions (100% vs 97%, p = 1.00; pIn patients with calcified non-type-C lesions, the treatment strategy with RA or MB before DES implantation results in comparable success rates, whereas in type-C lesions upfront RA appears to be the superior upfront strategy.
- Published
- 2021