Impact of the use of plaque modification techniques on coronary microcirculation using an angiography-derived index of microcirculatory resistance.

Autores de IIS La Fe

• Jorge Sanz Sánchez

  Autor

• José Antonio Sorolla Romero

  Autor

• José Luis Díez Gil

  Autor

• Jean Paul Vilchez Tschischke

  Autor

Participantes ajenos a IIS La Fe

• Teira Calderon, Andrea
• Sans-Rosello, Jordi
• Fernandez-Peregrina, Estefania
• Bosch-Peligero, Eduardo
• Sanchez-Cena, Juan
• Valcarcel-Paz, Daniel
• Jimenez-Kockar, Marcelo
• Asmarats, Lluis
• Millan-Alvarez, Xavier
• Martinez-Rubio, Antonio
• Garcia-Garcia, Hector M

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

Abstract

Many lesions in patients undergoing percutaneous coronary intervention (PCI) exhibit significant calcification. Several techniques have been developed to improve outcomes in this setting. However, their impact on coronary microcirculation remains unknown. The aim of this study is to evaluate the influence of plaque modification techniques on coronary microcirculation across patients with severely calcified coronary artery disease. In this multicenter retrospective study, consecutive patients undergoing PCI with either Rotablation (RA) or Shockwave-intravascular-lithotripsy (IVL) were included. Primary endpoint was the impairment of coronary microvascular resistances assessed by Delta angiography-derived index of microvascular resistance (DeltaIMRangio) which was defined as the difference in IMRangio value post- and pre-PCI. Secondary endpoints included the development of peri procedural PCI complications (flow-limiting coronary dissection, slow-flow/no reflow during PCI, coronary perforation, branch occlusion, failed PCI, stroke and shock developed during PCI) and 12-month follow-up adverse events. 162 patients were included in the analysis. Almost 80% of patients were male and the left descending anterior artery was the most common treated vessel. Both RA and IVL led to an increase in DeltaIMRangio (22.3 and 10.3; p=0.038, respectively). A significantly higher rate of PCI complications was observed in patients with DeltaIMRangio above the median of the cohort (21.0% vs. 6.2%; p=0.006). PCI with RA was independently associated with higher DeltaIMRangio values (OR 2.01, 95% CI: 1.01-4.03; p=0.048). Plaque modification with IVL and RA during PCI increases microvascular resistance. Evaluating the microcirculatory status in this setting might help to predict clinical and procedural outcomes and to optimize clinical results.