Author + information
- Soha Ahmad,
- Han Tun,
- Michael Gaglia,
- Anilkumar Mehra,
- Ray V. Matthews,
- David M. Shavelle and
- Leonardo Clavijo
Rotational atherectomy (RA) can aid in high risk Percutaneous Coronary Intervention (PCI) with hemodynamic support. There is concern that use of RA could result in increased procedural complications. We report our institution’s experience with RA in high risk PCI with hemodynamic support.
398 patients underwent high risk PCI with intraaortic balloon pump (IABP) (n=327), Impella (n=57), or Tandem Heart (n=14) between 2008 and July 2014. Patients with ST elevated myocardial infarction were excluded (n=129). Patients who underwent RA (n=34) were compared to those who did not (n=235). Among the 34 patients who underwent RA, Impella use (n=10) versus IABP use (n=23) was compared.
Patients in the RA arm were older (71.91±14.47 vs. 64.77±12.63, p=0.003) and less likely in cardiogenic shock (6% vs. 23%, p=0.02). There was no difference in the number of diseased vessels (RA= 2.86±0.88 vs. no RA =2.68±0.99, p=NS), location of vessels, or number of total occlusions (RA = 32% vs. no RA =32%, p=NS). PCI without stent deployment was less common in the RA arm (15% vs. 37%, p=0.01). There was no difference in stent diameter or length. There was a trend toward more Impella use, but this was not statistically different (RA = 29% vs. no RA =18%, p=NS). There was no difference in morbidity, hospital mortality, recurrent MI, or repeat revascularization. Within the rotational atherectomy group, there was no difference in outcome between IABP or Impella 2.5.
In our center’s experience, use of rotational atherectomy in high risk PCI with hemodynamic support is feasible and not associated with increased morbidity or mortality.