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Clinical outcomes after percutaneous coronary intervention with rotational atherectomy: insights from the RA-BIA
Paweł Kralisz1, Konrad Nowak1, Łukasz Kuźma1,2,3
1Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland.
Insights
Rotational atherectomy (RA) is effective for treating severe coronary calcification during percutaneous coronary intervention (PCI). This study shows RA offers high procedural success and remains crucial for complex coronary artery disease management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Severe coronary calcification presents significant challenges in percutaneous coronary intervention (PCI).
- Rotational atherectomy (RA) modifies calcified lesions, aiding stent delivery and expansion.
- RA may improve both procedural success and long-term outcomes in PCI.
Purpose of the Study:
- To assess temporal trends, procedural performance, and clinical outcomes of RA over 15 years.
- To evaluate RA's role in patients with heavily calcified coronary artery disease undergoing PCI.
- To analyze short- and long-term MACCE (major adverse cardiovascular and cerebrovascular events) at 24 months.
Main Methods:
- Retrospective analysis of 1060 patients undergoing RA and PCI over 15 years.
- Assessment of baseline characteristics, procedural success, and in-hospital complications.
- Evaluation of 24-month MACCE, including CV death, MI, TVR, and stroke.
Main Results:
- Technical and clinical success rates were high (97.6% and 86.2%).
- 30-day MACCE was 10.9%, and 24-month MACCE was 38.3% with 19.4% all-cause mortality.
- Reduced eGFR and higher SYNTAX I scores predicted increased MACCE; higher LVEF was protective.
Conclusions:
- Rotational atherectomy demonstrates high procedural success in complex coronary lesions.
- RA remains an indispensable tool in modern percutaneous coronary intervention.
- RA facilitates improved outcomes in patients with heavily calcified coronary artery disease.
Introduction:
Severe coronary calcification remains one of the major challenges in percutaneous coronary intervention (PCI). Rotational atherectomy (RA) facilitates calcium modification, improving stent delivery and expansion, and may therefore enhance both procedural and long‑term outcomes.
Objectives:
We aimed to evaluate the temporal trends, procedural performance, and short- and long‑term clinical outcomes of RA in patients with heavily calcified coronary artery disease treated with PCI over a 15‑year period in a single high‑volume center.
Patients And Methods:
Baseline characteristics, procedural outcomes, in‑hospital complications, and follow‑up were assessed. The primary end point was procedural and clinical success; the secondary end point included major adverse cardiovascular and cerebrovascular events (MACCEs; cardiovascular death, myocardial infarction, target vessel revascularization, stroke) at 24 months.
Results:
Among 1060 patients (median [interquartile range] age, 74 [66-80] y), diabetes and chronic kidney disease were present in 42% and 31.1%, respectively, and 63.8% had prior PCI. Multivessel disease was diagnosed in 36.4%, and 29.4% had the SYNTAX I value equal to or above 32. Technical and clinical success were 97.6% and 86.2%, respectively. Thirty‑day MACCE rate was 10.9%, while at 24 months the MACCE rate was 38.3% and all‑cause mortality rate was 19.4% (cardiovascular, 14.2%). Estimated glomerular filtration rate below 30 ml/min/1.73 m² (subdistribution hazard ratio [sHR], 1.61; 95% CI, 1.11-2.35; P = 0.01) and each 10‑point increase in the SYNTAX I score (sHR, 1.13; 95% CI, 1.04-1.23; P = 0.005) predicted higher MACCE rate, whereas higher left ventricular ejection fraction was protective (sHR, 0.984 per 5% increase; P <0.001). Isolated postprocedural troponin rise was not independently associated with outcomes (sHR, 1.22; P = 0.07).
Conclusions:
RA provides high procedural success even in the most complex lesions and remains an essential tool in contemporary PCI.
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