The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction

Abstract

BackgroundRotational atherectomy (RA) is an indispensable tool used for calcified lesion preparation in percutaneous coronary intervention (PCI). However, use of RA in the setting of acute myocardial infarction (AMI) is challenged with limited clinical data.ObjectivesThis study aims to retrospectively investigate the procedural results, periprocedural complications, and clinical outcomes of RA in patients with AMI.MethodsAll possible consecutive patients who received RA in AMI from January 2009 to March 2018 in a single tertiary center were analyzed retrospectively. Patients without AMI during the study period were also enrolled for comparison.ResultsA total of 121 patients with AMI (76.0 ± 10.8 years, 63.6% males) and 290 patients without AMI were recruited. Among the AMI group, 81% of patients had non-ST-elevation myocardial infarction (NSTEMI) and 14% presented with cardiogenic shock. RA could be completed in 98.8% of patients in the AMI group and 98.3% in the non-AMI group (p = 1.00). The periprocedural complication rates were comparable between the AMI and non-AMI groups. The risks of in-hospital, 30-day, 90-day, and 1-year cardiovascular major adverse cardiac events (CV MACE) were significantly higher in the AMI group compared with the non-AMI group (in-hospital 13.2 vs. 2.8%, p < 0.001; 30-day 14.2 vs. 4.5%, p < 0.001; 90-day 20.8 vs. 6.9%, p < 0.001; 1-year 30.8 vs. 19.1%, p = 0.01). AMI at initial presentation and cardiogenic shock were predictors for both in-hospital CV MACE and 1-year CV MACE in multivariable binary logistic regression analysis. Other predictors for 1-year CV MACE included serum creatinine level and triple vessel disease.ConclusionRA in patients with AMI is feasible with a high procedural completion rate and acceptable periprocedural complications. Given unstable hemodynamics and complex coronary anatomy, the in-hospital and 1-year MACE rates remained higher in patients with AMI compared with patients without AMI.

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

“…The duration of DAPT was further adjusted during the follow-up period after weighing the ischemic and bleeding risks. The above method was also reported in our previous work (15,16,30,31).…”

“…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)(16)(17). These variables were also independent predictors for major cardiovascular events in previous publication (12,23,(33)(34)(35)(36).…”

“…Under-expanded stents have been associated with poor long-term results (11). 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)(13)(14)(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).…”

Safety and Efficacy of Contemporary Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction and a High Ischemic Risk

“…Therefore, PCI for elderly patients with AMI is often more technically challenging, such as advancing balloons and stenting to the lesion, and it could be difficult to achieve stent optimization. Cutting balloon angioplasty and rotational atherectomy are used to overcome the severely calcified lesion, and a better prognosis can be expected through these procedures for calcified plaque modification, but it is not easy to perform such a complex procedure for culprit lesion in the setting of STEMI ( 16 ). Regarding elderly patients as the predictors of TLF in STEMI patients with high ischemic risk, it might be explained that the ischemic adverse events increase due to the limitation of stent optimization by lesion complexity in the elderly patients.…”