Directional coronary atherectomy (DCA): A report from the New Approaches to Coronary Intervention (NACI) registry

Ron Waksman, Jeffrey J. Popma, Elizabeth D. Kennard, Charles J. George, John S. Douglas, Michael Cowley, Martin B. Leon, David R. Holmes, Tomoaki Hinohara, Robert D. Safian, Carlton A. Hornung, Jeffrey A. Brinker, Gary S. Roubin, Raoul Bonan, Dean Kereiakes, Ray V. Matthews, Donald S. Baim

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Directional coronary atherectomy (DCA) with the Simpson coronary atherocath seeks to debulk rather than simply displace obstructive tissue and is a means of enlarging the stenotic coronary lumen. This report from the New Approaches to Coronary Intervention (NACI) registry describes the experience of 1,196 patients who underwent DCA as the sole treatment for either native vessel or vein graft lesions. Device success (post-DCA residual stenosis <50% and ≤20% improvement) was achieved in 87.8%, with a lesion success rate (postprocedural residual stenosis <50% and ≤20% improvement) of 94.0%. The mean resultant stenosis after all interventions (by core laboratory) was 19%. Significant in-hospital complications occurred in 2.8% of patients with DCA attempts, including death 0.6%, Q-wave myocardial infarction (MI) 1.5%, and emergent coronary artery bypass graft surgery (CABG) 2.8%. At 1-year follow- up, cumulative mortality was 3.6%, with repeat revascularization in 28% (repeat percutaneous transluminal coronary angioplasty, 20.1%; CABG, 10.6%). This reflected percutaneous or surgical revascularization of the original lesion (target lesion revascularization) in 22.6% of patients. Subgroup analysis showed a lower lesion success rate and an increased complication role for unplanned use, vein graft treatment, and treatment of a de novo (vs a restenotic) lesion. Multivariate analysis shows that diabetes mellitus, unstable angina, treatment of a restenotic lesion, and greater residual stenosis after the initial procedure were independent predictors of the composite endpoint of death/Q-wave MI/target lesion revascularization by 1- year follow-up. Among these generally favorable acute and 1-year results, the NACI directional atherectomy data confirm the 'bigger is better' hypothesis: that lesions with a lower residual stenosis after a successful procedure had significantly fewer target lesion revascularizations between 30 days and 1 year, with no increase in major adverse events.

Original languageEnglish (US)
Pages (from-to)50K-59K
JournalAmerican Journal of Cardiology
Volume80
Issue number10 A
DOIs
StatePublished - Nov 20 1997

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Waksman, R., Popma, J. J., Kennard, E. D., George, C. J., Douglas, J. S., Cowley, M., Leon, M. B., Holmes, D. R., Hinohara, T., Safian, R. D., Hornung, C. A., Brinker, J. A., Roubin, G. S., Bonan, R., Kereiakes, D., Matthews, R. V., & Baim, D. S. (1997). Directional coronary atherectomy (DCA): A report from the New Approaches to Coronary Intervention (NACI) registry. American Journal of Cardiology, 80(10 A), 50K-59K. https://doi.org/10.1016/S0002-9149(97)00764-9