Coronary atherectomy is associated with improved procedural and clinical outcomes among patients with calcified coronary lesions

Insights from the VA CART program

Ehrin J. Armstrong, Maggie A. Stanislawski, Damianos G. Kokkinidis, Mary E. Plomondon, Anna E. Barón, Jay Giri, Kendrick A. Shunk, Subhash Banerjee, Thomas M. Maddox, Stephen W. Waldo

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: We sought to evaluate the prevalence of calcified coronary lesions and the association between the use of atherectomy and clinical outcomes. Background: Calcified coronary arteries are associated with an increased risk of procedural complications during percutaneous coronary intervention (PCI). The outcomes of coronary atherectomy for adjunctive treatment of calcified coronary lesions are not well described. Methods: We identified all patients treated for calcified coronary lesions at VA hospitals. A propensity weighted cohort was created for those treated with or without adjunctive atherectomy to evaluate the complications and outcomes between groups. Results: From 2007 to 2015, 9,719 patients underwent single-vessel PCI for treatment of naïve native calcific coronary lesions. The proportion of patients undergoing revascularization of calcified lesions increased over the study period (P=0.03) and 1,731 patients (18%) were treated with atherectomy. Adjunctive atherectomy was more likely to be used in high-risk lesions (76.5% vs. 46.8%, P<0.001). After propensity weighting, coronary atherectomy was associated with a 38% decrease in the odds of procedural complications and a 54% decrease in the odds of clinical complications (both P=0.005). There was no difference in rates of 2-year death (HR: 1.07; 95% CI: 0.92-1.24), myocardial infarction (HR: 0.96; 95% CI: 0.75-1.23) or target vessel revascularization (HR: 0.96; 95% CI: 0.78-1.19) Conclusions: Percutaneous treatment of calcified coronary lesions has increased over time. The adjunctive use of coronary atherectomy was associated with a reduction in procedural complications among patients with calcified coronary arteries. Two-year TVR, MI and overall mortality were similar between the two groups.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

Coronary Atherectomy
Atherectomy
Percutaneous Coronary Intervention
Coronary Vessels
Therapeutics
Myocardial Infarction
Mortality

Keywords

  • Atherectomy
  • Calcium
  • Coronary artery calcification
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary atherectomy is associated with improved procedural and clinical outcomes among patients with calcified coronary lesions : Insights from the VA CART program. / Armstrong, Ehrin J.; Stanislawski, Maggie A.; Kokkinidis, Damianos G.; Plomondon, Mary E.; Barón, Anna E.; Giri, Jay; Shunk, Kendrick A.; Banerjee, Subhash; Maddox, Thomas M.; Waldo, Stephen W.

In: Catheterization and Cardiovascular Interventions, 2017.

Research output: Contribution to journalArticle

Armstrong, Ehrin J. ; Stanislawski, Maggie A. ; Kokkinidis, Damianos G. ; Plomondon, Mary E. ; Barón, Anna E. ; Giri, Jay ; Shunk, Kendrick A. ; Banerjee, Subhash ; Maddox, Thomas M. ; Waldo, Stephen W. / Coronary atherectomy is associated with improved procedural and clinical outcomes among patients with calcified coronary lesions : Insights from the VA CART program. In: Catheterization and Cardiovascular Interventions. 2017.
@article{6fe5000aa5304c70a874af04379ab64c,
title = "Coronary atherectomy is associated with improved procedural and clinical outcomes among patients with calcified coronary lesions: Insights from the VA CART program",
abstract = "Objectives: We sought to evaluate the prevalence of calcified coronary lesions and the association between the use of atherectomy and clinical outcomes. Background: Calcified coronary arteries are associated with an increased risk of procedural complications during percutaneous coronary intervention (PCI). The outcomes of coronary atherectomy for adjunctive treatment of calcified coronary lesions are not well described. Methods: We identified all patients treated for calcified coronary lesions at VA hospitals. A propensity weighted cohort was created for those treated with or without adjunctive atherectomy to evaluate the complications and outcomes between groups. Results: From 2007 to 2015, 9,719 patients underwent single-vessel PCI for treatment of na{\"i}ve native calcific coronary lesions. The proportion of patients undergoing revascularization of calcified lesions increased over the study period (P=0.03) and 1,731 patients (18{\%}) were treated with atherectomy. Adjunctive atherectomy was more likely to be used in high-risk lesions (76.5{\%} vs. 46.8{\%}, P<0.001). After propensity weighting, coronary atherectomy was associated with a 38{\%} decrease in the odds of procedural complications and a 54{\%} decrease in the odds of clinical complications (both P=0.005). There was no difference in rates of 2-year death (HR: 1.07; 95{\%} CI: 0.92-1.24), myocardial infarction (HR: 0.96; 95{\%} CI: 0.75-1.23) or target vessel revascularization (HR: 0.96; 95{\%} CI: 0.78-1.19) Conclusions: Percutaneous treatment of calcified coronary lesions has increased over time. The adjunctive use of coronary atherectomy was associated with a reduction in procedural complications among patients with calcified coronary arteries. Two-year TVR, MI and overall mortality were similar between the two groups.",
keywords = "Atherectomy, Calcium, Coronary artery calcification, Percutaneous coronary intervention",
author = "Armstrong, {Ehrin J.} and Stanislawski, {Maggie A.} and Kokkinidis, {Damianos G.} and Plomondon, {Mary E.} and Bar{\'o}n, {Anna E.} and Jay Giri and Shunk, {Kendrick A.} and Subhash Banerjee and Maddox, {Thomas M.} and Waldo, {Stephen W.}",
year = "2017",
doi = "10.1002/ccd.27213",
language = "English (US)",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Coronary atherectomy is associated with improved procedural and clinical outcomes among patients with calcified coronary lesions

T2 - Insights from the VA CART program

AU - Armstrong, Ehrin J.

AU - Stanislawski, Maggie A.

AU - Kokkinidis, Damianos G.

AU - Plomondon, Mary E.

AU - Barón, Anna E.

AU - Giri, Jay

AU - Shunk, Kendrick A.

AU - Banerjee, Subhash

AU - Maddox, Thomas M.

AU - Waldo, Stephen W.

PY - 2017

Y1 - 2017

N2 - Objectives: We sought to evaluate the prevalence of calcified coronary lesions and the association between the use of atherectomy and clinical outcomes. Background: Calcified coronary arteries are associated with an increased risk of procedural complications during percutaneous coronary intervention (PCI). The outcomes of coronary atherectomy for adjunctive treatment of calcified coronary lesions are not well described. Methods: We identified all patients treated for calcified coronary lesions at VA hospitals. A propensity weighted cohort was created for those treated with or without adjunctive atherectomy to evaluate the complications and outcomes between groups. Results: From 2007 to 2015, 9,719 patients underwent single-vessel PCI for treatment of naïve native calcific coronary lesions. The proportion of patients undergoing revascularization of calcified lesions increased over the study period (P=0.03) and 1,731 patients (18%) were treated with atherectomy. Adjunctive atherectomy was more likely to be used in high-risk lesions (76.5% vs. 46.8%, P<0.001). After propensity weighting, coronary atherectomy was associated with a 38% decrease in the odds of procedural complications and a 54% decrease in the odds of clinical complications (both P=0.005). There was no difference in rates of 2-year death (HR: 1.07; 95% CI: 0.92-1.24), myocardial infarction (HR: 0.96; 95% CI: 0.75-1.23) or target vessel revascularization (HR: 0.96; 95% CI: 0.78-1.19) Conclusions: Percutaneous treatment of calcified coronary lesions has increased over time. The adjunctive use of coronary atherectomy was associated with a reduction in procedural complications among patients with calcified coronary arteries. Two-year TVR, MI and overall mortality were similar between the two groups.

AB - Objectives: We sought to evaluate the prevalence of calcified coronary lesions and the association between the use of atherectomy and clinical outcomes. Background: Calcified coronary arteries are associated with an increased risk of procedural complications during percutaneous coronary intervention (PCI). The outcomes of coronary atherectomy for adjunctive treatment of calcified coronary lesions are not well described. Methods: We identified all patients treated for calcified coronary lesions at VA hospitals. A propensity weighted cohort was created for those treated with or without adjunctive atherectomy to evaluate the complications and outcomes between groups. Results: From 2007 to 2015, 9,719 patients underwent single-vessel PCI for treatment of naïve native calcific coronary lesions. The proportion of patients undergoing revascularization of calcified lesions increased over the study period (P=0.03) and 1,731 patients (18%) were treated with atherectomy. Adjunctive atherectomy was more likely to be used in high-risk lesions (76.5% vs. 46.8%, P<0.001). After propensity weighting, coronary atherectomy was associated with a 38% decrease in the odds of procedural complications and a 54% decrease in the odds of clinical complications (both P=0.005). There was no difference in rates of 2-year death (HR: 1.07; 95% CI: 0.92-1.24), myocardial infarction (HR: 0.96; 95% CI: 0.75-1.23) or target vessel revascularization (HR: 0.96; 95% CI: 0.78-1.19) Conclusions: Percutaneous treatment of calcified coronary lesions has increased over time. The adjunctive use of coronary atherectomy was associated with a reduction in procedural complications among patients with calcified coronary arteries. Two-year TVR, MI and overall mortality were similar between the two groups.

KW - Atherectomy

KW - Calcium

KW - Coronary artery calcification

KW - Percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85026645396&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026645396&partnerID=8YFLogxK

U2 - 10.1002/ccd.27213

DO - 10.1002/ccd.27213

M3 - Article

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

ER -