Rotablation with or without other calcium debulking therapies is a safe adjunctive procedure for patients with severe coronary calcification requiring Percutaneous Coronary Intervention (PCI).
This is a prospective observational multicenter cohort study of all patients with calcified coronary lesions undergoing RA in participating centres across Asia. Patients will be required to provide informed consent for data collection, including follow-up data and uploading of data on a web-based data collection platform (deidentified). Operators/ institution coordinators will fill up hardcopy or electronic (web-based) forms including patient's baseline demographics, co-morbidities, clinical data, laboratory test results, echocardiography results, coronary angiography findings with subsequent interventions performed as well as follow-up clinical and laboratory results. Note that while detailed data for individual patients will only be collected if there is informed consent, data from each institution will also be collected for aggregate data regarding procedural volume (eg. total cases with debulking therapy and specifically for ROTABLATORTM). This will give a sense of representativeness of data collected. This screening data will also include the following fields: age, gender, ethnicity, comorbidities, target vessel, prior revascularization (PCI/CABG), clinical presentation, procedural urgency, angiographic procedural details (RA and PCI) and in-hospital complication and mortality. The use of this retrospective data will require appropriate approval and will only utilize anonymized data. Only in-hospital data will be obtained and no follow up data is required from these controls. Should these data not be available in any of the participating sites, a minimum baseline demographics, procedural and inpatient outcome data with reasons for non-participation in registry should be provided for records purposes. This shall be accepted as a limitation of the study. Sub-site analysis may be performed in centres with availability of all data in this group of patients to address generalisability of the data collected.
Study Type
OBSERVATIONAL
Enrollment
1,000
Rotational atherectomy (RA) has been the most used atherectomy modality since its first inception in1988. RA uses high speed rotation (140,000 - 180,000 rpm) to ablate inelastic plaque, resulting in debris averaging 5µm in size24. The main focus of RA in the era of DES stent has been on plaque modification rather that plaque debulking with more papers showing improved PCI success rates.
Kokura Memorial hospital
Kitakyushu, Japan
RECRUITINGNational Heart Centre Singapore
Singapore, Singapore
RECRUITINGPrimary efficacy endpoint (Procedural success)
Procedural success defined as \< 20% residual stenosis in treated segment without on-table mortality with TIMI 3 flow.
Time frame: Duration of procedure
Death
in-hospital and at 1-year follow-up
Time frame: 1 year
Periprocedural myocardial infarction (MI)
1. Peak CK-MB ≥ 10x ULN OR ≥ 5x ULN + new pathologic Q waves in ≥ 2 contiguous leads/ new persistent LBBB2 OR 2. Peak Troponin T or I \> 5x ULN + new pathologic Q waves/ ischemic ECG changes
Time frame: within 48 hours of procedure
Complications
Significant coronary perforation at least Type II, III or III CS based on Ellis classification
Time frame: within 48 hours of procedure
Complication
no-reflow or slow flow
Time frame: within 48 hours of procedure
Procedural time
Time of guide engagement to removal of guide
Time frame: Duration of procedure
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