Author + information
Severe coronary calcification adversely influences success of percutaneous coronary intervention. Rotational atherectomy (RA) (Boston Scientific) and orbital atherectomy (OA) (Diamondback 360® (CSI)) are used to modify plaque and help facilitate stent delivery to improve clinical outcomes. We sought to identify predictors of procedural complications (PC) while performing coronary atherectomy.
Between June 2010 and July 2015, all patients at a single center who had attempted treatment with RA or OA were retrospectively evaluated. Demographic, procedural, and clinical data were collected by chart review. Two interventional cardiologists independently reviewed each cineangiography to record lesion traits and angiographic outcomes. Predefined PC were noted including: dissection, perforation, reduced or no TIMI flow, or side branch loss. Univariate analyses were conducted to see which variables significantly related to any PC. After a Bonferroni correction, multivariate logistic regression analysis was performed to find a model that predicted PC.
A total of 62 procedures out of 274 had PC. In the OA group 32 patients and in the RA group 29 patients suffered such complication. Significant differences in PC were found based on univariate analyses presented in the Table. Significant predictors on multivariate analysis included TIMI Flow Post Wire (p<0.003) and having a clinical complication (p<0.004). While type of device was not a significant predictor (p=0.121), the odds of having a procedural complication were 42% lower for those who received the RA.
Successful wiring of severely calcified coronary artery stenosis is the most important predictor of having uncomplicated successful coronary atherectomy procedures. The modality of atherectomy does not predict procedural complications.