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Predictors of periprocedural myocardial infarction after rotational atherectomy
Michał Błaszkiewicz1, Kamila Florek1, Wojciech Zimoch2
1Students' Scientific Group of Invasive Cardiology, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Insights
Periprocedural myocardial infarction (MI) occurred in 8% of patients undergoing rotational atherectomy (RA). Independent predictors included no/slow flow and higher SYNTAX Score, while prior coronary artery bypass grafting (CABG) and non-dilatable lesions were protective.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Rotational atherectomy (RA) is effective for calcified plaques but carries perceived risks.
- Understanding periprocedural myocardial infarction (MI) in RA is crucial for patient safety.
Purpose of the Study:
- To determine the frequency of periprocedural MI after RA.
- To identify factors predicting periprocedural MI in patients undergoing RA.
Main Methods:
- Retrospective observational study of 534 patients.
- Periprocedural MI defined by the 4th universal definition of MI.
- Logistic regression analysis to identify predictors.
Main Results:
- Periprocedural MI occurred in 8% of patients.
- Predictors included older age, higher SYNTAX Score (>33), and no/slow flow.
- Prior coronary artery bypass grafting (CABG) and non-dilatable lesions were associated with lower MI rates.
Conclusions:
- Periprocedural MI is a notable complication of RA, seen in nearly 1 in 12 patients.
- Female gender, older age, and severe coronary disease are implicated.
- No/slow flow increases risk, while prior CABG and non-dilatable lesions decrease risk.
Introduction:
Rotational atherectomy (RA) presents superior efficacy over traditional balloon angioplasty in managing calcified plaques, albeit being associated with a perceived heightened aggressiveness and increased risk of periprocedural complications.
Aim:
To assess the frequency and predictive factors of periprocedural myocardial infarction (MI) following RA.
Material And Methods:
This was a retrospective observational study, encompassing 534 patients. The definition of periprocedural MI was consistent with the 4th universal definition of MI.
Results:
Periprocedural MI occurred in 45 (8%) patients. This subset tended to be older (74.6 ±8.2 vs. 72 ±9.3%; p = 0.04) with SYNTAX Score (SS) > 33 points (p = 0.01), alongside elevated rates of no/slow flow (p = 0.0003). These patients less often fulfilled the indication for RA, which is a non-dilatable lesion. The incidence of traditional risk factors was similar in both groups. Univariable logistic regression models revealed: male gender (OR = 0.54; p = 0.04), non-dilatable lesion (OR = 0.41; p = 0.01), prior coronary artery bypass grafting (CABG) (OR = 0.07; p = 0.01) as negative and SS > 33 (OR = 2.8; p = 0.02), older age (OR = 1.04; p = 0.04), no/slow flow (OR = 7.85; p = 0.002) as positive predictors. The multivariable model showed that occurrence of no/slow flow (OR = 6.7; p = 0.02), SS > 33 (OR = 2.95; p = 0.02), non-dilatable lesion (OR = 0.42; p = 0.02), and prior CABG (OR = 0.08; p = 0.02) were independent predictors of periprocedural MI.
Conclusions:
Periprocedural MI after RA was not an uncommon complication, occurring in nearly one-twelfth of patients. Our analysis implicated female gender, older age, and more severe coronary disease in its occurrence. As expected, the presence of no/slow flow amplified the risk of periprocedural MI, whereas prior CABG and non-dilatable lesions mitigated this risk.
