The following is a summary of “Lower revascularization rates after high-speed rotational atherectomy compared to modified balloons in calcified coronary lesions: 5-year outcomes of the randomized PREPARE-CALC trial,” published in the March 2024 issue of Cardiology by Mankerious et al.
In the PREPARE-CALC trial, utilizing rotational atherectomy (RA) for severely calcified lesion preparation before implanting biodegradable polymer sirolimus-eluting stents (SES) resulted in increased procedural success and similar rates of acute lumen gain and late lumen loss when compared to modified balloons (MB) (scoring/cutting).
Researchers conducted a retrospective study to assess the 5-year outcomes of both strategies for lesion preparation.
They randomly allocated 200 patients in a 1:1 ratio to either MB or RA, followed by implantation of SES in the PREPARE-CALC trial. The primary endpoint for this analysis was the occurrence of target vessel failure (TVF) over 5 years.
The results showed that at the 5-year mark, MB and RA had comparable rates of TVF (19% vs. 21%, HR 1.14, 95% CI 0.60–2.16, P=0.687). Subgroup analysis indicated a lesion length treatment interaction, with MB being favorable for short lesions and RA for long ones (p for interaction = 0.042). TLR was significantly less standard with RA (12 vs. 3%, HR 0.28, 95% CI 0.08–0.98, P=0.048). Multivariate analysis revealed that RA independently protected against TLR (adj. HR 0.17, 95% CI 0.04–0.78, P=0.022), while ostial lesions were associated with higher TLR irrespective of treatment strategy (adj. HR 11.3, 95% CI 2.98–42.6, P<0.001).
Investigators concluded that, while both techniques (MB and RA) achieved similar bypass rates after 5 years, RA significantly reduced the need for repeat procedures compared to MB, suggesting RA’s potential long-term benefit in these patients.
Source: link.springer.com/article/10.1007/s00392-024-02434-1