Early and Intermediate Outcomes After Rotational Atherectomy in Octogenarian Patients

OBJECTIVE: To provide information about the use of rotational atherectomy in octogenarians. MATERIAL AND METHODS: From 1993-1996, 26 octogenarians underwent coronary intervention with rotablator at Emory University Hospitals. The total number of lesions were 28 (57% of them in the left artery descending). Adjunctive balloon angioplasty was utilized in 26 lesions. The lesions were eccentric in 82%, calcified in 75%, with a mean length of 10.2Â+/-8.5 mm. RESULTS: The angiographic success rate was 96.2%. The only in-hospital complications was the death of 1 patient (3.8%) after an abrupt closure, and a dissection of 1 lesion of another patient, with a favorable subsequent outcome. The mean follow up was 1.3Â+/-0.4 years. The Kaplan-Meier survival rate at 1 year was 96.2% and at 2 years 78.3%. The freedom from death, myocardial infarction (MI), and coronary artery bypass graft (CABG) was 88.5% at 1 year and 59.7 % at 1.5 and 2 years. The freedom from death, MI, CABG, and percutaneous transluminal coronary angioplasty (PTCA) was 69.2% at one year and 36.3% at 1.5 and 2 years. CONCLUSIONS: In octogenarians with complex lesions, rotablator was performed in conjunction with balloon angioplasty, and showed a high rate of angiographic success, a relatively low complication rate, and a favorable 2 years survival rate. Nevertheless, the event free rates did not show the same favorable evolution after 1 year. If feasible, it would be useful to conduct randomized trials in the elderly to compare interventional procedures to medical treatment or surgery. (c)1999 by CVRR, Inc.