Search

espanolIntroduccion y objetivos: El objetivo del estudio fue investigar si la evaluacion no invasiva del indice de calcificacion coronaria mediante tomografia computarizada cardiaca multidetector (TCMD) puede predecir la necesidad de una aterectomia rotacional (AR) electiva durante la intervencion coronaria percutanea. Metodos: Se incluyeron pacientes diagnosticados de estenosis coronaria grave con placas moderadamente o gravemente calcificadas durante la angiografia coronaria. Esos pacientes se sometieron a la cuantificacion del indice de calcificacion coronaria con la escala de Agatston utilizando TCMD y posteriormente a intervencion percutanea. Solo fueron tratadas con AR las lesiones que se consideraba que no era posible cruzar ni dilatar, segun un protocolo de revascularizacion predisenado. Ninguno de los operadores conocia de antemano los resultados de la TCMD. Segun el protocolo del estudio, en el analisis estadistico se incluyeron variables clinicas, angiograficas y relacionadas con la puntuacion Agatston. Durante el seguimiento se estudiaron los resultados a corto y largo plazo en ambos grupos. Resultados: Se analizaron 40 pacientes: 20 que recibieron AR y 20 con intervencion coronaria percutanea convencional. La mayoria se incluyo despues de un sindrome coronario agudo y tenian una anatomia coronaria compleja (puntuacion media de la escala Syntax de 25 puntos). La creatinina y la puntuacion de Agatston por lesion fueron los unicos factores predictivos de la AR. No se observaron diferencias significativas en el pronostico dentro del hospital o a largo plazo. Un nuevo parametro, el indice CAC-Cre, fue util para predecir la necesidad de AR. Conclusiones: El analisis de la calcificacion de las arterias coronarias mediante la puntuacion de Agatston mejora la evaluacion no invasiva de las placas coronarias complejas antes de la intervencion coronaria percutanea. La puntuacion de Agatston por lesion, la creatinina serica y el indice CAC-Cre son parametros utiles para predecir la necesidad de una AR electiva durante la intervencion coronaria percutanea. EnglishIntroduction and objectives: This study aims to investigate if the non-invasive assessment of coronary calcium score using multislice cardiac computerized tomography (MSCT) may anticipate the need for elective rotational atherectomy (RA) during percutaneous coronary intervention. Methods: Patients were considered eligible for the study after receiving a diagnosis of severe coronary stenosis with moderate or severely calcified plaques during index coronary angiography. Those patients underwent the Agatston coronary artery calcium (CAC) score quantification using the MSCT and then underwent percutaneous intervention. Only those lesions considered non-crossable or non-dilatable according to a pre-specified revascularization protocol were treated with RA. All operators were blinded to the MSCT results. According to the study protocol, clinical, angiographic and Agatston-related variables were included in the statistical analysis. Short and long-term outcomes were investigated in both treatment groups during follow-up. Results: A total of 40 patients were included in the analysis: 20 underwent RA and 20 conventional percutaneous coronary interventions. Most patients were included after suffering from an acute coronary syndrome and had complex coronary anatomy (mean Syntax score, 25 points). The logistic regression analysis showed that creatinine levels and the per-lesion Agatston score were the only predictors of RA. No significant differences were observed regarding in-hospital or long-term procedural outcomes. A novel parameter, the CAC-Cre index, was found to be useful to anticipate the need for RA. Conclusions: Coronary artery calcification analysis using the Agatston score is a simple technique that improves the non-invasive assessment of complex coronary plaques prior to percutaneous coronary intervention. The per-lesion Agatston score, serum creatinine levels, and the CAC-Cre index may become useful parameters to anticipate the need for elective RAs during percutaneous coronary intervention.