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[In-hospital major complications associated with rotational atherectomy: experience with 800 patients at a single
R Moreno1, E García, L Pérez de Isla
1Servicio de Cardiología, Hospital Gregorio Marañón, Madrid.
Insights
Rotational atherectomy for high-risk coronary lesions has a 6.5% major adverse cardiac event rate. Diabetes and de novo lesions independently predict higher event rates, while age and prior infarction do not significantly impact prognosis.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease Research
Context:
- Rotational atherectomy is a key intervention for complex coronary artery disease.
- Understanding post-procedure outcomes is crucial for patient management.
Purpose:
- To assess the incidence of major adverse cardiac events (MACE) following rotational atherectomy.
- To identify clinical and procedural factors associated with MACE.
Summary:
- This study analyzed 800 patients undergoing rotational atherectomy, reporting a 6.5% MACE rate (death, infarction, revascularization).
- Independent predictors of MACE included diabetes and treatment of de novo lesions.
- Factors like advanced age, prior infarction, and left ventricular dysfunction were not significantly associated with MACE.
Impact:
- Identifies specific patient groups at higher risk for adverse events after rotational atherectomy.
- Informs clinical decision-making and risk stratification for patients undergoing this procedure.
- Highlights the need for tailored management strategies for diabetic patients and those with de novo lesions.
Introduction:
Rotational atherectomy is usually performed in patients with angiographically determined high risk coronary lesions. The aim of this study was to evaluate the rate of major adverse cardiac events (death, Q-wave infarction or new revascularization) after rotational atherectomy, as well as to identify the clinical characteristics associated with this incidence.
Patients And Methods:
The study population included 800 patients treated with rotational atherectomy from 1993 to 1999: 512 (64%), for de novo lesions, and 288 (36%) for restenosis. Balloon dilation and coronary stenting was performed in 95% and 34% of patients, respectively.
Results:
During hospitalization, 17 patients (2.1%) died, 16 (2%) had a Q-wave infarction, 30 (3.8%) a non-Q infarction, and new revascularization was performed in 28 (3.5%). The incidence of major adverse cardiac events was 6.5% (n = 52), this incidence being higher in the presence of diabetes (8.9 vs. 4.4%; p = 0.01), unstable angina or acute/recent myocardial infarction (7.6 vs. 3.3%; p = 0.02), multivessel disease (8.6 vs. 3.3%; p < 0.01), treated vessel other than right coronary (7.0 vs. 1.7%; p = 0.01), procedure in > 1 vessel (10.7 vs. 4.7%; p < 0.01), angiographic failure (62.5 vs. 5.5%; p < 0.001), and de novo lesions (8.4 vs. 2.5%; p < 0.01), with diabetes and treatment of de novo lesions being independent predictors of major adverse cardiac events. However, age, previous infarction, and left ventricular dysfunction, were not associated with the rate of events.
Conclusion:
Some simple variables are associated with a higher incidence of major adverse cardiac events after rotational atherectomy. Advanced age, previous infarction and left ventricular dysfunction, however, do not necessarily imply a poorer prognosis in these patients.