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Utilization and out...
Utilization and outcomes of rotational atherectomy in Sweden
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- Venetsanos, D. (författare)
- Karolinska University Hospital, Stockholm, Sweden
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- Erlinge, D. (författare)
- Skåne University Hospital, Lund, Sweden
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- Omerovic, E. (författare)
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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- Calais, Fredrik, 1971- (författare)
- Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiology
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- Angeras, O. (författare)
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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- Jensen, J. (författare)
- Karolinska Institute, Department of Cardiology, Capio St. Görans Hospital, Stockholm, Sweden
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- Henareh, L. (författare)
- Karolinska University Hospital, Stockholm, Sweden
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- Todt, T. (författare)
- Skåne University Hospital, Lund, Sweden
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- Gotberg, M. (författare)
- Skåne University Hospital, Lund, Sweden
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- Sarno, G. (författare)
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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- Aasa, M. (författare)
- Karolinska Institute, Department of Cardiology, Södersjukhuset AB, Stockholm, Sweden
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- Lagerqvist, B. (författare)
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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- James, S. (författare)
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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- Alfredsson, J. (författare)
- Linköping University Hospital, Cardiology,Linköping, Sweden
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(creator_code:org_t)
- 2020-11-25
- 2020
- Engelska.
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 41:Suppl. 2, s. 2528-2528
- Relaterad länk:
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https://academic.oup...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Aim: To evaluate utilization and outcomes of rotational atherectomy (RA) using data from the Swedish Coronary and Angioplasty Registry (SCAAR).Methods: We included 1476 patients with 2218 lesions who underwent RA from 2005 to 2016. To study temporal changes, the study period was divided into three equal time-periods, period A, B and C.Results: Although the number of RA procedures increased 3-fold from 2005 to 2016, the rate of RA (of all PCI procedures) remained low (0.5% vs 1.2% in 2005 vs 2016). RA patients consisted a high-risk group, with advanced age and clustering of comorbidities. Over time, included patients were older and had a higher risk profile. Trans-radial access, drug eluting stent (DES) use and use of intravascular imaging significantly increased from period A to C whereas positioning of a temporary pacemaker or intra-aortic balloon pump declined. Unfractionated heparin became the main anticoagulant (52 vs 87%) and use of glycoprotein IIb/IIIa inhibitors declined (31 vs 12%, in period A vs C). Following RA, 11% of lesions were treated without stent (15 vs 15 vs 8%, in period A, B and C) (Rota-only). In lesions treated with a stent, a bare metal stent (BMS) was implanted in 39% vs 12% vs 2% and a new generation DES (N-DES) in 5 vs 75 vs 97% (period A vs B vs C) of lesions.The 3-year cumulative rate of restenosis was 6.7% (122 events), (11.1 vs 7.1 vs 4.1% in period A vs B vs C). As compared to DES, rota-only (adjusted HR 2.71; 95% CI 1.69- 4.36) and BMS (adjusted HR 3.63; 95% CI 2.27- 5.81) were associated with significantly higher risk for restenosis. First generation DES were associated with numerically higher but not significantly different risk for restenosis as compared to N-DES (adjusted HR 1.31; 95% CI 0.74- 2.31).The 3 year cumulative rate of major adverse cardiac events (MACE), including death, myocardial infarction (MI) or any restenosis was 30.6% (34.2 vs 31.4 vs 28.2%, in period A vs B vs C) and the corresponding numbers for all-cause mortality were 18.1% (18.9 vs 18.4 vs 17.0%). After adjustment for baseline characteristics and angiographic findings, RA in period A was associated with higher risk for MACE as compared to period C (adjusted HR 1.40; 95% CI 1.09- 1.79), due to higher risk for MI and restenosis. The difference disappeared when procedural characteristics, including DES use, were added to the model.The rate of major in-hospital complications was 7.0%, including in-hospital death 1.3%, periprocedural MI 2.8%, perforation 1.1%, cardiac tamponade 0.7%, stroke 0.2% and major bleedings 2.1%. We found no significant differences over time.Conclusion: During the studied period, RA remained a rare procedure, utilised in a highly selected population. Over time a declining rate of restenosis and MI after RA was observed, a finding that appeared to be mainly driven by an increased use of DES. The rate of major in-hospital complication remained low.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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Venetsanos, D.
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Erlinge, D.
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Omerovic, E.
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Calais, Fredrik, ...
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Angeras, O.
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Jensen, J.
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Henareh, L.
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Todt, T.
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Gotberg, M.
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Sarno, G.
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Aasa, M.
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Lagerqvist, B.
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James, S.
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Alfredsson, J.
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