title: Regional calcified plaque score evaluated by multidetector computed tomography for predicting the addition of rotational atherectomy during percutaneous coronary intervention.
abstract: BACKGROUND
  Rotational atherectomy (rotablation) has been proposed as a potentially superior strategy for percutaneous coronary intervention (PCI) in complex and severely calcified lesions.
  
  
  OBJECTIVE
  We hypothesized that a per-lesion coronary artery calcium score determined by multidetector computed tomography (MDCT) would be useful for predicting the requriement for rotablation during PCI.
  
  
  METHODS
  MDCT was performed in patients with stable angina pectoris who were scheduled for first PCI. In 116 consecutive subjects (168 target lesions) with successful PCI, MDCT and quantitative coronary angiography (QCA) data were retrospectively evaluated regarding their ability to predict rotablation.
  
  
  RESULTS
  PCI without rotablation was performed in 105 patients (154 lesions), and rotablation was added in 11 patients (14 lesions). Patients with rotablation had significantly higher SYNTAX scores (p = 0.007) and total calcium scores (p < 0.001) than those without rotablation. Per-lesion, a lesion length ≥20 mm and diameter stenosis ≥74% on QCA as well as a per-lesion calcium score ≥453 and calcification arc ≥270 in MDCT predicted rotablation. After adjustment for potential confounding variables, a high per-lesion calcium score was an independent predictor of rotablation (odds ratio 31.3, 95% confidence interval 2.8-345, p = 0.005, sensitivity 93% and specificity 88%).
  
  
  CONCLUSIONS
  The extent of target lesion calcification in MDCT, a simple marker of calcified plaque, is useful for predicting the need for rotablation during PCI.
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Sekimoto
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan; Department of Internal Medicine (Cardiology), Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Karasuyama Hospital, Japan. Electronic address: hzn01233@s02.itscom.net.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Akutsu
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hamazaki
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Koshiro
authors.initials: K
authors.lastname: Sakai
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Kosaki
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tsujita
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tsukamoto
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Kaneko
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sakurai
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kodama
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Li
authors.affiliation: Department of Pharmacology, Showa University School of Medicine, Japan; Department of Internal Medicine (Cardiology), Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Karasuyama Hospital, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Sambe
authors.affiliation: Department of Pharmacology, Showa University School of Medicine, Japan.
authors.forename: Katsuji
authors.initials: K
authors.lastname: Oguchi
authors.affiliation: Department of Pharmacology, Showa University School of Medicine, Japan; Department of Internal Medicine (Cardiology), Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Karasuyama Hospital, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Uchida
authors.affiliation: Department of Internal Medicine (Cardiology), Clinical Research Institute for Clinical Pharmacology & Therapeutics, Showa University Karasuyama Hospital, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiovascular Surgery, Showa University School of Medicine, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Aoki
authors.affiliation: Department of Radiology, Showa University School of Medicine, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Gokan
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000000981:diagnostic imaging* / Q000628:therapy*; D019540:Area Under Curve; D017225:Atherectomy, Coronary; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000628:therapy*
keywords: Calcification; Coronary artery disease; Multidetector computed tomography coronary angiography; Quantitative coronary angiographic analysis; Rotational atherectomy