Rotablation in the Very Elderly - Safer than We Think?

Area of Science:

• Cardiology
• Interventional Cardiology
• Geriatric Cardiology

Background:

• Calcified coronary artery stenosis presents a significant challenge for Percutaneous Coronary Intervention (PCI).
• Rotablation is a key technique for calcium modification during PCI, used in 1-3% of cases.
• Limited data exists on rotablation outcomes in patients aged 80 years and older, who are perceived to be at higher risk.

Purpose of the Study:

• To compare the outcomes of PCI with rotablation between patients aged 80 years and older and those younger than 80 years.
• To evaluate in-hospital outcomes and 30-day mortality risk in these distinct age groups.

Main Methods:

• A retrospective analysis of consecutive patients undergoing rotablation and PCI across three UK centers from 2014-2017.
• Comparison of in-hospital composite outcomes (including stroke, myocardial infarction, death, and procedural complications) and 30-day mortality risk scores between the two age groups.
• Data collected included baseline characteristics, angiographic findings, access site, and clinical outcomes.

Main Results:

• A total of 213 patients were included, with 71 (33.3%) aged 80 years or older.
• Older patients were more likely to present with acute coronary syndrome (ACS) (53.5% vs. 33.8%) and had longer hospital stays (2.8 vs. 1.3 days).
• In-hospital composite outcomes were similar between groups (5.6% vs. 4.9%), with no significant difference (p=1.0). The 30-day mortality risk score was higher in the older group (2.5% vs. <1%).

Conclusions:

• PCI with rotablation in very elderly patients (≥80 years) yields outcomes comparable to younger patients.
• Despite a higher incidence of ACS and increased perceived risk, elderly patients undergoing rotablation experience similar in-hospital safety profiles.
• These findings support the use of rotablation in carefully selected elderly patients with complex coronary artery disease.