Impact of diabetes mellitus on periprocedural and 18-month clinical outcomes in Korean patients requiring rotational atherectomy: results from the ROCK Registry

초록

BACKGROUND: Diabetes mellitus (diabetes) increases the risk of se- vere coronary artery calcification, which increases the complexity of percutaneous coronary intervention requiring rotational atherectomy (RA) by interfering with lesion preparation, and limiting final stent ex- pansion.OBJECTIVE: Investigate 30-day and 18-month clinical outcomes in pa- tients with and without diabetes treated with percutaneous coronary intervention requiring RA.DESIGN: Medical record reviewSETTING: Multicenter registry in South KoreaPATIENTS AND METHODS: The ROtational atherectomy in Calcified lesions in Korea (ROCK) registry was a large, retrospective, multicenter study to assess RA treatment of severe coronary artery calcification.MAIN OUTCOME MEASURES: The primary endpoint was target -ves-sel failure including cardiac death, target-vessel myocardial infarction, and target-vessel revascularization.SAMPLE SIZE: 540 patients followed for a median of 16.1 months.RESULTS: Of the 540 patients, 305 had diabetes (56.5%). The diabe- tes group had a significantly higher frequency of multivessel disease; comorbidities such as hypertension, dyslipidemia, and chronic kidney disease; and lower ejection fraction of the left ventricle compared to the non-diabetes group (n=235). There were no significant differences in procedure success and complications observed between the two groups. Target vessel failure at 30 days between the diabetes and non -diabetes groups was not statistically significant in a multivariate Cox regression analysis (1.6% vs. 2.6%, adjusted hazard ratio [HR] 0.595, 95% confidence interval [CI] 0.154-2.300, P=.451). During an 18-month follow-up, the risk of target vessel failure was higher (12.5% vs. 8.9%) but the difference was not statistically significant (adjusted HR 1.393, 95% CI 0.782-2.482, P=.260).CONCLUSIONS: Patients with diabetes have a risk of complications comparable to patients without diabetes, and 30-day and 18-month clinical outcomes are similar in severe coronary artery calcification re-quiring RA, despite having more comorbidities.

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