Coronary Artery Calcification
Conditions
Keywords
Atherosclerotic Calcification, Medial Artery Calcification, Rotational Atherectomy
Brief summary
Rotablation with or without other calcium debulking therapies is a safe adjunctive procedure for patients with severe coronary calcification requiring Percutaneous Coronary Intervention (PCI).
Detailed description
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.
Interventions
PROCEDURERotational Atherectomy
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.
Sponsors
Boston Scientific Corporation
National Heart Centre Singapore
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Able to understand and sign an informed consent form * Presence of clinical indication for percutaneous coronary intervention (PCI) and/or stent placement * Subjects willing to comply with all research and follow-up requirements. * Angiographic criteria (ONE of the following criteria MUST be met) 1. Target lesions visually have at least moderate calcifications\* 2. Target lesion balloon dilatation failure 3. Inability of devices (microcatheters, balloons or stents) to pass through the target lesion. * Procedural criteria 1. All patients treated with RA with or without other forms of debulking therapy * Moderate calcification is defined as radio-opacities noted only during cardiac cycle prior to contrast injection whereas severe calcification is defined as radio-opacities seen without cardiac motion prior to contrast injection, usually affecting both sides of the arterial lumen.
Exclusion criteria
* Decline to give consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Primary efficacy endpoint (Procedural success) | Duration of procedure | Procedural success defined as \< 20% residual stenosis in treated segment without on-table mortality with TIMI 3 flow. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complications | within 48 hours of procedure | Significant coronary perforation at least Type II, III or III CS based on Ellis classification |
| Death | 1 year | in-hospital and at 1-year follow-up |
| Periprocedural myocardial infarction (MI) | within 48 hours of procedure | 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 |
| Complication | within 48 hours of procedure | no-reflow or slow flow |
| Procedural time | Duration of procedure | Time of guide engagement to removal of guide |
Countries
Japan, Singapore
Contacts
Primary ContactJames Low
Backup ContactPhoebe Chin
Outcome results
None listed