Outcomes of coronary rotational atherectomy in patients with reduced left ventricular ejection fraction
Hui-Ping Zhang1, Ying Zhao1, Hu Ai1
1Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, P.R. China.
Insights
Rotational atherectomy (RA) is safe and effective for severe coronary artery calcification, even with reduced left ventricular ejection fraction (LVEF). However, lower LVEF independently predicts higher major adverse cardiac events within two years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Severe coronary artery calcification (CAC) poses challenges for percutaneous coronary intervention (PCI).
- Rotational atherectomy (RA) is used to treat severe CAC.
- The safety and efficacy of RA in patients with reduced left ventricular ejection fraction (LVEF) require further evaluation.
Purpose of the Study:
- To evaluate the safety and efficacy of RA in patients with reduced LVEF.
- To compare procedural success and complication rates across different LVEF groups.
- To assess the impact of LVEF on long-term cardiac events after RA.
Main Methods:
- Retrospective analysis of 140 patients with severe CAC undergoing RA.
- Patients categorized into three LVEF groups: ≤35%, 36%-50%, and >50%.
- Assessment of procedural success, periprocedural complications, and 2-year major adverse cardiac events (MACE).
Main Results:
- High procedural success rates observed across all LVEF groups.
- Minor periprocedural complications were common; major complications were rare.
- The 2-year MACE rate was significantly higher in the LVEF ≤35% group (40.0%) compared to the LVEF >50% group (6.7%).
Conclusions:
- RA demonstrates similar procedural success in patients with reduced or preserved LVEF.
- Reduced LVEF is an independent predictor of 2-year MACEs in patients with severe CAC undergoing RA and subsequent PCI.
- LVEF is a critical factor in risk stratification for patients undergoing RA for severe CAC.
Objective:
We evaluated the safety and efficacy of rotational atherectomy (RA) in patients with a reduced left ventricular ejection fraction (LVEF).
Methods:
In total, 140 consecutive patients with severe coronary artery calcification (CAC) who underwent RA were retrospectively enrolled. Patients were grouped based on LVEF: ≤35% (n = 10), 36% to 50% (n = 11), and >50% (n = 119). We assessed procedural success and periprocedural complication rates as well as the incidences of in-hospital and 2-year major adverse cardiac events (MACEs), defined as hospitalization for myocardial infarction and worsening heart failure, target vessel revascularization, and cardiac death.
Results:
Procedural success was achieved in nearly all patients in each group. Most periprocedural complications were minor, and major complications were uncommon. The 2-year MACE rate was significantly higher in the LVEF ≤35% than LVEF >50% group (40.0% vs. 6.7%, respectively). Multivariable regression analysis revealed that the LVEF was the only independent predictor of 2-year MACEs in patients who underwent RA.
Conclusions:
Patients with a reduced LVEF who underwent RA had procedural success rates similar to those of patients with preserved left ventricular systolic function. The LVEF might be an independent predictor of 2-year MACEs in patients with severe CAC after percutaneous coronary intervention following RA.
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