Author + information
Percutaneous coronary intervention (PCI) of heavily calcified lesions is a challenge for the interventional cardiologist. The aim of this study was to investigate the immediate and long-term outcome of patients (pts) treated with rotational atherectomy (RA).
All consecutive pts treated by PCI with RA at our center between 09/1998-12/2011 entered in a database and were analyzed retrospectively. Clinical indication were Acute Coronary Syndrome in 148 pts (52%). Data of early and late (mean follow-up 69±52 months) major adverse cardiac events (MACE) included cardiac death, stroke, acute myocardial infarction (AMI) and target lesion failure (TLF).
A total of 283 pts (306 lesions) were included. Mean age was 70±10, 80% were male, 33% diabetic and 42% had chronic renal failure (CRF). 234 pts (83%) had multivessel disease. According to ACC/AHA classification, 79% were type C. Mean vessel diameter was 3.3±0.4 mm. After RA, cutting-balloon (CB) was used in 35% of cases. Drug eluting stents (DES) were implanted in 44% of pts, bare metal (BMS) in 47%. Pts were divided in two groups, according to Burr/Artery Ratio (BAR): group 1 (BAR≤ 0.5 plus cutting-balloon use, 64%) and group 2 (BAR>0.5 with or without cutting-balloon, 31%). Procedural success was 96.6%, early mortality 1.4%, stroke or TIA 1.4%, acute renal injury 5.3%. CK-MB rise > 5x Upper Limit value occurred in 2.8% of pts and vessel perforation in 1.4%. CRF (95% CI,1.2-1.7,p=0.03), Peripheral Artery Disease (CI 95%1.6-6.6,p=0.006), no use of cutting-balloon in lesion treated with BAR ≤ 0.5 (CI 95% 1.2-42.3, p=0.0001) and transient/persistent slow-no flow (CI 95% 1.5-9.8, p=0.01) were independent predictor of MACEs. Persistent no-slow flow occurred significantly less in group 1 (0.5% vs 1.9%,p=0.01), like as coronary perforation (0.5% vs 3.9%, p=0.001) and acute stent thrombosis (2.4 vs 0%,p=0.01). The incidence of MACE was significantly lower in group 1 at 6 months (5.4% vs 9.8%,p=0.03), 1 year (7.1% and 12.2%,p=0.001) and 5 years (17.7% vs 31.3%, p=0.001).
RA is maybe a safe technique in the treatment of complex lesions, with high success rate. A “minimalistic approach” using small BAR and the CB (Rota-Cut technique) followed by DES implantation, seems promising in reducing complications and improving outcome. Further studies are necessary in order to support these registry data.
- 2013 American College of Cardiology Foundation