Short-term and long-term outcomes of bailout versus planned coronary rotational atherectomy

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Rotational atherectomy (RA) is a percutaneous coronary intervention (PCI) technique used to treat complex coronary artery lesions.
• The decision to use RA can be either planned or as a bailout strategy following procedural complications.
• Understanding the comparative outcomes of planned versus bailout RA is crucial for optimizing patient care.

Purpose of the Study:

• To compare in-hospital and long-term clinical outcomes between planned and bailout rotational atherectomy (RA) during percutaneous coronary intervention (PCI).
• To evaluate the incidence of procedural complications, major adverse cardiac events (MACE), and mortality in both groups.
• To assess the impact of RA strategy on procedural time.

Main Methods:

• A retrospective study including 211 patients who underwent PCI with RA from November 2011 to December 2018 at Nanjing Drum Tower Hospital.
• Patients were categorized into planned RA (before balloon pre-dilation) and bailout RA (after procedural failure) groups.
• In-hospital and long-term MACE (cardiac mortality, myocardial infarction, target vessel revascularization, stroke) were compared.

Main Results:

• The bailout RA group exhibited a significantly higher incidence of coronary dissection (22.4% vs. 6.5%, P=0.001) compared to the planned RA group.
• No significant differences were observed in in-hospital MACE (12.1% vs. 13.7%, P=0.752), all-cause mortality (9.1% vs. 12.5%, P=0.504), or long-term MACE (13.8% vs. 17.1%, P=0.560) between the groups.
• Bailout RA was associated with a significantly longer procedural time (139.86 ± 56.24 min vs. 105.56 ± 36.71 min, P < 0.001).

Conclusions:

• Planned RA is associated with a lower incidence of coronary dissection and shorter procedural times compared to bailout RA.
• Both planned and bailout RA strategies demonstrate similar rates of in-hospital and long-term MACE and mortality.
• The findings suggest that a planned approach to RA may offer procedural advantages without compromising patient safety regarding major adverse cardiac events.