Comparative evaluation of one-year outcomes between stent and non-stent strategies following atherectomy for severely calcified coronary lesions
H Nohara, Y Egami, T Mukai, A Sugino, N Kobayashi, M Abe, S Kawanami, N Okamoto, Y Matsunaga-Lee, M Yano, M NishinoAbstract
Background
Atherectomy using rotational (RA) or orbital (OA) devices facilitates percutaneous coronary intervention (PCI) in severely calcified lesions. However, the optimal revascularization strategy following plaque modification remains uncertain.
Purpose
We aimed to compare one-year clinical outcomes between stent and non-stent strategies after atherectomy under intravascular imaging guidance.
Methods
We retrospectively analyzed 425 severely calcified lesions treated with RA or OA between October 2019 and June 2024. Intravascular ultrasound or optical coherence tomography was used in all cases for lesion assessment and procedural optimization. Patients were categorized into a stent strategy group or a non-stent strategy group. Procedural success was defined as ≤30% residual stenosis with TIMI 3 flow and dissection grade A–C. The primary endpoint was one-year target lesion revascularization (TLR). Secondary endpoints included target vessel revascularization (TVR), major adverse cardiac events (MACE: cardiac death, target-vessel myocardial infarction, or heart failure hospitalization), and all-cause mortality. Kaplan–Meier analysis and log-rank testing were performed. Propensity score matching (PSM) was applied to adjust for baseline differences.
Results
Before PSM, the stent strategy was associated with lower one-year TLR (5.8% vs 12.6%, p<0.001) and TVR (8.0% vs 14.0%, p=0.003), with no significant differences in MACE (p=0.133) or all-cause mortality (p=0.151). After PSM (125 matched pairs), the stent strategy remained associated with reduced TLR (8.0% vs 13.8%, p=0.011) and TVR (8.8% vs 13.8%, p=0.021), whereas MACE (p=0.809) and all-cause mortality (p=0.488) were comparable between groups.
Conclusion
In severely calcified lesions treated with atherectomy under intravascular imaging guidance, stent implantation was associated with fewer repeat revascularizations but did not improve survival or reduce major adverse cardiac events at one year.TLR Rate After PSMFor image description, please refer to the figure legend and surrounding text.