Author + information
- Hoyle L. Whiteside III,
- Supawat Ratanapo,
- Arun Nagabandi and
- Deepak Kapoor
In elderly patients, percutaneous coronary intervention (PCI) is associated with worse short-term outcomes and increased rates of angiographic complications. Furthermore, severe coronary artery calcification (CAC) decreases the probability of optimal PCI. Many patients with severe CAC benefit from lesion modification with rotational atherectomy (RA), however the safety and feasibility of RA in the elderly is not well-established.
We retrospectively identified all patients; age greater than 75, undergoing RA over a three-year period. Data regarding patient demographics, procedural characteristics, and incidence of major adverse cardiac events (MACE) was collected.
Twenty-eight patients were included in data analysis. Demographic data, procedural characteristics, and clinical outcomes are reported in Table 1. Procedural success was achieved in all cases and no MACE occurred within 30 days of PCI. At 6 months, 17.9% (5/24) of patients had experienced MACE. The incidence of MACE was driven by NSTEMI, Type II MI, and target vessel revascularization. Two deaths were reported. One patient developed ventricular tachycardia while undergoing sigmoidectomy and the other was enrolled in hospice care for metastatic malignancy.
RA is an indispensable tool in the elderly population, as they are more likely to have CAC and other comorbidities that limit their candidacy for surgical revascularization. In our population, RA was successful in all cases and procedural complications were rare. RA is a safe and feasible technique that should be considered in elderly patients with severe CAC.