Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis
BackgroundSeverely calcified coronary lesions with reduced left ventricular (LV) function result in worse outcomes. Atherectomy is used in treating such lesions when technically feasible. However, there is limited data examining the safety and efficacy of atherectomy without hemodynamic support in t...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.946027/full |
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| author | Waiel Abusnina Mostafa Reda Mostafa Ahmad Al-Abdouh Qais Radaideh Mahmoud Ismayl Mahboob Alam Jaffer Shah Noraldeen El Yousfi Timir K. Paul Itsik Ben-Dor Khagendra Dahal |
| author_facet | Waiel Abusnina Mostafa Reda Mostafa Ahmad Al-Abdouh Qais Radaideh Mahmoud Ismayl Mahboob Alam Jaffer Shah Noraldeen El Yousfi Timir K. Paul Itsik Ben-Dor Khagendra Dahal |
| author_sort | Waiel Abusnina |
| collection | DOAJ |
| description | BackgroundSeverely calcified coronary lesions with reduced left ventricular (LV) function result in worse outcomes. Atherectomy is used in treating such lesions when technically feasible. However, there is limited data examining the safety and efficacy of atherectomy without hemodynamic support in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction (LVEF).ObjectiveTo evaluate the clinical outcomes of atherectomy in patient with reduced LVEF.MethodsWe searched PubMed, Cochrane CENTRAL Register and ClinicalTrials.gov (inception through July 21, 2021) for studies evaluating the outcomes of atherectomy in patients with severe LV dysfunction. We used random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI). The endpoints were in-hospital and long term all-cause mortality, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).ResultsA total of 7 studies consisting of 2,238 unique patients were included in the analysis. The median follow-up duration was 22.4 months. The risk of in-hospital all-cause mortality using atherectomy in patients with severely reduced LVEF compared to the patients with moderate reduced or preserved LVEF was [2.4vs.0.5%; RR:5.28; 95%CI 1.65–16.84; P = 0.005], the risk of long term all-cause mortality was [21 vs. 8.8%; RR of 2.84; 95% CI 1.16–6.95; P = 0.02]. In-hospital TVR risk was 2.0 vs. 0.6% (RR: 4.15; 95% CI 4.15–15.67; P = 0.04) and long-term TVR was [6.0 vs. 9.9%; RR of 0.75; 95% CI 0.39–1.42; P = 0.37]. In-hospital MI was [7.1 vs. 5.4%; RR 1.63; 95% CI 0.91–2.93; P = 0.10], long-term MI was [7.5 vs. 5.7; RR 1.74; 95%CI 0.95–3.18; P = 0.07).ConclusionOur meta-analysis suggested that the patients with severely reduced LVEF when using atherectomy devices experienced higher risk of clinical outcomes in the terms of all-cause mortality and cardiac mortality. As we know that the patients with severely reduced LVEF are inherently at increased risk of adverse clinical outcomes, this information should be considered hypothesis generating and utilized while discussing the risks and benefits of atherectomy in such high risk patients. Future studies should focus on the comparison of outcomes of different atherectomy devices in such patients. Adjusting for the inherent mortality risk posed by left ventricular dysfunction may be a strategy while designing a study. |
| first_indexed | 2024-04-11T10:00:15Z |
| format | Article |
| id | doaj.art-226e073ec1774bf2aa08656ebd40ca97 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T10:00:15Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-226e073ec1774bf2aa08656ebd40ca972022-12-22T04:30:26ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-09-01910.3389/fcvm.2022.946027946027Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysisWaiel Abusnina0Mostafa Reda Mostafa1Ahmad Al-Abdouh2Qais Radaideh3Mahmoud Ismayl4Mahboob Alam5Jaffer Shah6Noraldeen El Yousfi7Timir K. Paul8Itsik Ben-Dor9Khagendra Dahal10Department of Cardiology, Creighton University School of Medicine, Omaha, NE, United StatesDepartment of Medicine, Rochester Regional/Unity Hospital, Rochester, NY, United StatesDepartment of Medicine, University of Kentucky, Lexington, KY, United StatesDepartment of Cardiology, Creighton University School of Medicine, Omaha, NE, United StatesDepartment of Cardiology, Creighton University School of Medicine, Omaha, NE, United StatesSection of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United StatesMedical Research Center, Kateb University, Kabul, AfghanistanTripoli Medical Center, Tripoli, LibyaDepartment of Medical Education, University of Tennessee at Nashville, Nashville, TN, United StatesSection of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United StatesDepartment of Cardiology, Creighton University School of Medicine, Omaha, NE, United StatesBackgroundSeverely calcified coronary lesions with reduced left ventricular (LV) function result in worse outcomes. Atherectomy is used in treating such lesions when technically feasible. However, there is limited data examining the safety and efficacy of atherectomy without hemodynamic support in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction (LVEF).ObjectiveTo evaluate the clinical outcomes of atherectomy in patient with reduced LVEF.MethodsWe searched PubMed, Cochrane CENTRAL Register and ClinicalTrials.gov (inception through July 21, 2021) for studies evaluating the outcomes of atherectomy in patients with severe LV dysfunction. We used random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI). The endpoints were in-hospital and long term all-cause mortality, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).ResultsA total of 7 studies consisting of 2,238 unique patients were included in the analysis. The median follow-up duration was 22.4 months. The risk of in-hospital all-cause mortality using atherectomy in patients with severely reduced LVEF compared to the patients with moderate reduced or preserved LVEF was [2.4vs.0.5%; RR:5.28; 95%CI 1.65–16.84; P = 0.005], the risk of long term all-cause mortality was [21 vs. 8.8%; RR of 2.84; 95% CI 1.16–6.95; P = 0.02]. In-hospital TVR risk was 2.0 vs. 0.6% (RR: 4.15; 95% CI 4.15–15.67; P = 0.04) and long-term TVR was [6.0 vs. 9.9%; RR of 0.75; 95% CI 0.39–1.42; P = 0.37]. In-hospital MI was [7.1 vs. 5.4%; RR 1.63; 95% CI 0.91–2.93; P = 0.10], long-term MI was [7.5 vs. 5.7; RR 1.74; 95%CI 0.95–3.18; P = 0.07).ConclusionOur meta-analysis suggested that the patients with severely reduced LVEF when using atherectomy devices experienced higher risk of clinical outcomes in the terms of all-cause mortality and cardiac mortality. As we know that the patients with severely reduced LVEF are inherently at increased risk of adverse clinical outcomes, this information should be considered hypothesis generating and utilized while discussing the risks and benefits of atherectomy in such high risk patients. Future studies should focus on the comparison of outcomes of different atherectomy devices in such patients. Adjusting for the inherent mortality risk posed by left ventricular dysfunction may be a strategy while designing a study.https://www.frontiersin.org/articles/10.3389/fcvm.2022.946027/fullreduced ejection fractionleft ventricular dysfunctionsevere coronary calcificationatherectomypercutaneous coronary intervention |
| spellingShingle | Waiel Abusnina Mostafa Reda Mostafa Ahmad Al-Abdouh Qais Radaideh Mahmoud Ismayl Mahboob Alam Jaffer Shah Noraldeen El Yousfi Timir K. Paul Itsik Ben-Dor Khagendra Dahal Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis Frontiers in Cardiovascular Medicine reduced ejection fraction left ventricular dysfunction severe coronary calcification atherectomy percutaneous coronary intervention |
| title | Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis |
| title_full | Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis |
| title_fullStr | Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis |
| title_full_unstemmed | Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis |
| title_short | Outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction: A systematic review and meta-analysis |
| title_sort | outcomes of atherectomy in treating severely calcified coronary lesions in patients with reduced left ventricular ejection fraction a systematic review and meta analysis |
| topic | reduced ejection fraction left ventricular dysfunction severe coronary calcification atherectomy percutaneous coronary intervention |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.946027/full |
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