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Practices and outcomes of rotational atherectomy in China: The Rota China registry
Xiao Wang1,2, Hong Zhang3, Xiaojun Bai4
1Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Beijing, China.
Insights
Rotational atherectomy (RA) effectively treats severe coronary calcified lesions in China, demonstrating high procedural success and favorable short-term and long-term outcomes. This study highlights RA
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology
Background:
- Rotational atherectomy (RA) remains a key treatment for severe coronary calcified lesions.
- Despite newer techniques, RA's role in contemporary practice requires evaluation.
- This study focuses on RA practices and outcomes in China.
Purpose of the Study:
- To evaluate contemporary clinical practices and outcomes of Rotational Atherectomy (RA) in China.
- To assess the safety and efficacy of RA in treating severe coronary calcified lesions.
- To identify predictors of adverse events following RA procedures.
Main Methods:
- Prospective, multicenter registry (Rota China Registry) of patients undergoing RA.
- Standardized protocol recommended for RA procedures.
- Primary safety endpoint: 30-day Major Adverse Cardiovascular Events (MACE). Primary efficacy endpoint: procedural success.
Main Results:
- 980 patients enrolled across 19 sites in China between July 2018 and December 2020.
- High procedural success rate of 91.1%.
- 30-day MACE rate of 4.9% and 1-year MACE rate of 8.2%. Total lesion length and renal insufficiency identified as predictors for MACE.
Conclusions:
- Rotational atherectomy is effective in achieving high procedural success.
- RA demonstrates good short- and long-term outcomes in Chinese patients with severely calcified lesions.
- Contemporary use of RA in China yields favorable results.
Background:
Rotational atherectomy (RA) remains an integral tool for the treatment of severe coronary calcified lesions despite emergence of newer techniques. We aimed to evaluate the contemporary clinical practices and outcomes of RA in China.
Methods:
The Rota China Registry (NCT03806621) was an investigator-initiated, prospective, multicenter registry based on China Rota Elite Group. Consecutive patients treated with RA were recruited. A pre-designed, standardized protocol was recommended for the RA procedure. The primary safety endpoint was major adverse cardiovascular events (MACE: composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) at 30 days. The primary efficacy endpoint was procedural success.
Results:
Between July 2018 and December 2020, 980 patients were enrolled at 19 sites in China. Mean patient age was 68.4 years, and 61.4% were men. Radial access was used in 79.1% patients, and 32.7% procedures were guided by intravascular imaging. A total of 22.6% procedures used more than 1 burr, and the maximal burr size was ≥1.75 mm in 24.4% cases, with burr upsizing in 19.3% cases, achieving a final burr-to-artery ratio of 0.52. Procedural success was achieved in 91.1% of patients, and the rate of 30-day and 1-year MACE was 4.9% and 8.2%, respectively. Multivariable analysis identified the total lesion length (HR 1.014, 95% CI: 1.002-1.027; p = 0.021) as predictor of 30-day MACE, and renal insufficiency (HR 1.916, 95% CI: 1.073-3.420; p = 0.028) as predictor of 1-year MACE.
Conclusions:
In this contemporary prospective registry in China, the use of RA was effective in achieving high procedural success rate with good short- and long-term outcomes in patients with severely calcified lesions.
