Rotablation in Patients with Advanced Renal Insufficiency through End-Stage Renal Disease: Short- and Intermediate-Term Results

Abstract

Objective. Patients with advanced renal insufficiency are at high risk of coronary artery disease (CAD) and complex lesions. Treating complex calcified lesion with rotational atherectomy (RA) in these patients might be associated with higher risks and poorer outcomes. This study was set to evaluate features and outcomes of RA in these patients. Method. Consecutive patients who received coronary RA from April 2010 to April 2018 were queried from the Cath Lab database. The procedural details, angiography, and clinical information were reviewed in detail. Results. A total of 411 patients were enrolled and divided into Group A (baseline serum creatinine <5 mg/dl, n = 338) and Group B (baseline serum creatinine ≥ 5 mg/dl through ESRD, n = 73). Most patients had high-risk features (65.7% of acute coronary syndrome (ACS), 14.1% of ischemic cardiomyopathy, and 5.1% of cardiogenic shock). Group B patients were significantly younger (66.8 ± 11.4 vs. 75.2 ± 10.7 years, p < 0.001 ) and had more RCA and LCX but less LAD treated with RA. No difference was found in lesion location, vessel tortuosity, bifurcation lesions, chronic total occlusion, total lesion length, or total lesion numbers between the two groups. Less patients in Group B obtained completion of RA (95.9% vs 99.1%, p = 0.037 ). There was no difference in the incidence of procedural complication or acute contrast-induced nephropathy. Group B patients had more deaths and MACE while in the hospital. The MACE and CV MACE were also higher in Group B patients at 180 days and one year, mostly due to TLR and TVR. Multivariate regression analysis showed that ACS, age, peripheral artery disease (PAD), advanced renal insufficiency, ischemic cardiomyopathy/shock, and high residual SYNTAX score were independent risk factors for in-hospital MACE, whereas ACS, advanced renal insufficiency, ischemic cardiomyopathy/shock, triple-vessel disease, and PAD independently predicted MACE at 6 months. Conclusions. Rotablation is feasible, safe, and could be carried out with very high success rate in very-high-risk patients with advanced renal dysfunction through ESRD without an increase in procedural complication.

Rotational atherectomy for chronically and totally occluded coronary lesions: A propensity score-matched outcomes study

“…Differences in categorical data were compared using the Chi-square test and differences in continuous variables were measured by the unpaired Student’s t -test. As our previous studies found that age, renal function (in serum creatinine), multivessel disease (tripe vessel disease plus left main), acute coronary syndrome (ACS), ischemic cardiomyopathy (or cardiogenic shock) and the use of mechanical circulatory support were significant predictors for MACEs in our population ( 15 – 17 ), and these variables were also predictors of multivariate analyzes in various rotablation registries in European countries ( 13 ), UK ( 32 ), Germany ( 33 ), Poland ( 34 ), Italy ( 35 ), and Japan ( 12 , 36 ). A propensity score-matched analysis was performed to select controls with matched baseline factors to assess the outcomes of RA for CTO lesions as compared with RA for non-CTO lesions, using a matching tolerance of 0.0001.…”

“…However, their use of RA for CTO involved patients who were significantly younger and had much more stable angina, which would otherwise confound the outcome assessment. In our previous publications, we have identified age, diabetes, renal insufficiency, ACS, shock, ischemic cardiomyopathy, MVD, and residual Syntax score as prognostic factors of short and intermediate outcomes ( 15 – 17 ). These variables were also independent predictors for major cardiovascular events in previous publication ( 12 , 23 , 33 – 36 ).…”

“…The outcomes of rotablation for coronary lesions could be affected by various clinical factors such as age, diabetes, renal insufficiency, LV function, and acute coronary syndrome ( 12 – 15 ). In our previous studies, we have identified age, diabetes, renal insufficiency, ACS, cardiogenic shock, and residual Syntax score as prognostic factors for short and intermediate outcomes ( 16 , 17 ). Despite several studies having reported on the feasibility of rotablation for CTO lesions ( 4 , 18 – 25 ), only two of them compared RA for CTO vs. RA for non-CTO lesions ( 26 , 27 ).…”