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Early and Intermediate Outcomes After Rotational Atherectomy in Octogenarian Patients
Claudia F. Gravina Taddei1, William S. Weintraub, Spencer King
1Dante Pazzanese Institute of Cardiology, Brazil; and the Division of Cardiology, Emory Center for Outcomes Research, Emory University, Atlanta, GA.
The American Journal of Geriatric Cardiology
|June 21, 2001
Summary
Rotational atherectomy in octogenarians with complex coronary lesions demonstrated high angiographic success and a favorable 2-year survival rate. However, event-free survival decreased after one year, suggesting a need for further comparative studies.
Area of Science:
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Octogenarians represent a growing population with complex coronary artery disease.
- Optimal treatment strategies for complex lesions in the elderly remain a subject of investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of rotational atherectomy in octogenarians with complex coronary lesions.
- To assess short- and medium-term clinical outcomes following rotational atherectomy in this patient group.
Main Methods:
- Retrospective analysis of 26 octogenarians undergoing rotational atherectomy between 1993-1996.
- Detailed assessment of lesion characteristics (eccentricity, calcification, length) and procedural success.
- Follow-up included survival rates and freedom from major adverse cardiac events (MACE).
Main Results:
- High angiographic success rate (96.2%) with rotational atherectomy and adjunctive balloon angioplasty.
- Low in-hospital complication rate, with one death (3.8%) due to abrupt closure.
- Kaplan-Meier survival at 2 years was 78.3%; freedom from death, MI, and CABG was 59.7% at 2 years.
Conclusions:
- Rotational atherectomy is a feasible and effective option for complex coronary lesions in octogenarians, offering good short-term outcomes.
- While survival remains favorable, event-free rates decline after one year, highlighting potential long-term challenges.
- Further randomized trials are warranted to compare interventional approaches with medical management or surgical revascularization in elderly patients.