Abstract 11965: Impact of Atherothrombotic Risk Stratification in Patients With Heavily Calcified Lesions Following Rotational Atherectomy

Background: Patients who undergo percutaneous coronary intervention (PCI) with rotational atherectomy (RA) are at high risk of adverse clinical outcomes, and there are few clinical risk stratification tools for these patients. The Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) is a simple 9-point risk stratification tool. A previous study reported that TRS 2°P was useful in predicting adverse clinical events in patients with acute coronary syndrome. However, it is unclear whether TRS 2°P predicts adverse clinical events in patients with heavily calcified lesions, requiring RA.

Hypothesis: This study aimed to investigate whether TRS 2°P is useful for the prediction of adverse clinical events in patients undergoing PCI with RA from the Japanese multicenter PCI registry.

Methods: We conducted a study with 196 patients who underwent PCI with RA out of 7,391 patients who underwent PCI in a multicenter, prospective cohort registry. Patients were divided into 3 groups according to the tertiles of the TRS 2°P: 65 patients in the T1 group (TRS 2°P<3), 66 patients in the T2 group (TRS 2°P=3), and 65 patients in the T3 group (TRS 2°P>3). The primary endpoint was the cumulative 2-year incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of cardiac death, acute coronary syndrome, and ischemic stroke.

Results: A cumulative 2-year MACCE occurred in 41 (24%) patients during the follow-up period. The cumulative incidence of MACCE was significantly higher in the T3 group than in T1 group (log-rank p=0.02). Multivariate Cox analyses revealed that the T3 group was associated with an increased risk of MACCE compared to T1 group (adjusted hazard ratio, 2.66; 95% confidence interval, 1.04–6.77; p=0.04). The addition of TRS 2°P to conventional risk factors, including male sex, number of diseased vessels, and low-density lipoprotein cholesterol levels, improved the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.39, p=0.027; IDI 0.072, p<0.001).

Conclusions: Atherothrombotic risk stratification using TRS 2°P is useful for identifying high-risk patients with heavily calcified lesions following RA.