Background and Objectives: Data is still limited regarding clinical outcomes of rotational atherectomy (RA) after percutaneous coronary intervention. We sought to evaluate clinical outcomes of RA. Materials and Methods: This multi-center registry enrolled patients who underwent RA during PCI from nine tertiary centers in Korea between January 2010 and October 2019. The primary endpoint was target-vessel failure (TVF; the composite outcome of cardiac death, target-vessel spontaneous myocardial infarction, or target-vessel revascularization). Results: Of 540 patients (583 lesions), the mean patient age was 71.4 ± 0.4 years, 323 patients (59.8%) were men, and 305 patients (56.5%) had diabetes mellitus. Technical success rate was 96.4%. In-hospital major adverse cerebral and cardiac events occurred in 63 cases (10.8%). At 1.5 years, 72 (16.0%) of TVFs were occurred. We evaluated independent predictors of TVF, which included current smoker (hazard ratio (HR), 1.92; 95% confidence interval (CI), 1.17–3.16; p = 0.01), chronic renal disease (HR, 1.87; 95% CI, 1.14–3.08; p = 0.013), history of cerebrovascular attack (HR, 2.14; 95% CI, 1.24-3.68; p = 0.006), left ventricle ejection fraction (HR, 0.98; 95% CI, 0.97–0.999; p = 0.037), and left main disease (HR, 1.94; 95% CI, 1.11–3.37; p = 0.019). Conclusions: From this registry, we demonstrated acceptable success rates, in-hospital and mid-term clinical outcomes of RA in the DES era.

Background: The secondary prevention with pharmacologic therapy is essential for preventing recurrent cardiovascular events in patients experiencing acute myocardial infarction. Guideline‐based optimal medical therapy (OMT) for patients with acute myocardial infarction consists of antiplatelet therapy, angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers, β‐blockers, and statins. We aimed to determine the prescription rate of OMT use at discharge and to evaluate the impact of OMT on long‐term clinical outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention in the drug‐eluting stent era using nationwide cohort data. Methods and Results: Using the National Health Insurance claims data in South Korea, patients with acute myocardial infarction who had undergone percutaneous coronary intervention with a drug‐eluting stent between July 2013 and June 2017 were enrolled. A total of 35 972 patients were classified into the OMT and non‐OMT groups according to the post–percutaneous coronary intervention discharge medication. The primary end point was all‐cause death, and the 2 groups were compared using a propensity‐score matching analysis. Fifty‐seven percent of patients were prescribed OMT at discharge. During the follow‐up period (median, 2.0 years [interquartile range, 1.1–3.2 years]), OMT was associated with a significant reduction in the all‐cause mortality (adjusted hazard ratio [aHR], 0.82 [95% CI, 0.76–0.90]; P <0.001) and composite outcome of death or coronary revascularization (aHR, 0.89 [95% CI, 0.85–0.93]; P <0.001). Conclusions: OMT was prescribed at suboptimal rates in South Korea. However, our nationwide cohort study showed that OMT has a benefit for long‐term clinical outcomes on all‐cause mortality and composite outcome of death or coronary revascularization after percutaneous coronary intervention in the drug‐eluting stent era.

Korean Circulation Journal 대한심장학회지 순환기 Yoon YH, et al. Korean Circ J. 2021 Nov;52:e5. https://doi.org/10.4070/kcj.2021.0240

Percutaneous coronary intervention (PCI) for bifurcation lesions presents several difficulties and often results in suboptimal procedural, postprocedural clinical outcomes. While the provisional 1-stent strategy is generally favored for its simplicity and favorable outcomes, a few studies suggest no significant difference between 1-stent and 2-stent techniques for true bifurcation lesions. Drug-eluting balloons (DEBs) have demonstrated potential in small vessel disease, including bifurcation side branches. However, no studies have compared the 2-stent strategy with the provisional 1-stent plus DEB strategy in non-LM true bifurcation lesions. Our study aims to address this gap by comparing these strategies, with a focus on real-world practice and detailed endpoint analysis. The PROVISION-DEB study is an open-label, randomized, multicenter clinical trial designed to investigate noninferiority and compare a 1-stent strategy with a drug-eluting balloon and a planned 2-stent strategy at non-LM coronary true-bifurcation lesions. A total of 750 patients with de novo non-LM coronary bifurcation lesions undergoing coronary interventions will be randomized 1:1 to either a provisional 1-stent plus DEB strategy or a 2-stent strategy with stratified Diabetes. The primary endpoint is a target lesion failure, composite outcome of cardiac death, target vessel myocardial infarction, or target lesion revascularization at the anticipated 3 years follow-up (6, 12, and 36 months). In conclusion, PROVISION-DEB study is a randomized, multicenter, noninferior clinical trial and will compare a 1-setnt strategy with a drug-eluting balloon and a planned 2-stent strategy at non-LM coronary true-bifurcation.