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Published on: April 25, 2014
Predictors of Clinical Outcomes in Myocardial Infarction Patients Underwent Coronary Intervention With Rotational
Ding-Sen Huang1, Chih-Yuan Fang1, Su-Kai Hsueh1
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Insights
Rotational atherectomy-assisted PCI is safe for myocardial infarction (MI) patients, showing similar procedural success to non-MI patients. While early outcomes were worse in MI patients, long-term survival rates were comparable.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Rotational atherectomy (RA) is used for calcified coronary arteries, but its role in myocardial infarction (MI) is unclear.
- Percutaneous coronary intervention (PCI) outcomes in MI patients undergoing RA require further investigation.
Purpose of the Study:
- To compare clinical outcomes of RA-assisted PCI in patients with and without MI.
- To evaluate the safety and efficacy of RA-assisted PCI in the context of acute MI.
Main Methods:
- Retrospective analysis of 152 patients undergoing RA-assisted PCI (2020-2024).
- Patients were stratified into MI (n=52) and non-MI (n=100) groups.
- Primary endpoints included all-cause mortality, cardiovascular death, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE).
Main Results:
- Procedural success rates were high and similar in both groups (98.1% vs. 99.0%).
- MI patients had poorer baseline characteristics (lower ejection fraction, worse renal function) and higher early MACE and TLR rates.
- After 1 year, clinical outcomes, including TLR-free survival, were comparable between groups.
Conclusions:
- RA-assisted PCI is feasible and safe in MI patients, with procedural success and complication rates similar to non-MI patients.
- Reduced left ventricular ejection fraction and renal dysfunction predicted 1-year mortality in MI patients.
- Long-term target lesion revascularization-free survival was not significantly different between MI and non-MI groups.
Objectives:
Rotational atherectomy (RA) is an established strategy for modifying heavily calcified coronary arteries, but its value in myocardial infarction (MI) remains uncertain. This study compared the clinical outcomes of RA-assisted percutaneous coronary intervention (PCI) in MI and non-MI patients.
Material And Methods:
We retrospectively analyzed 152 patients undergoing RA-assisted PCI at a tertiary center (2020-2024). Patients were stratified into MI (n = 52) and non-MI (n = 100) groups. Baseline characteristics, procedural outcomes, and follow-up events were compared. The primary endpoints were all-cause mortality, cardiovascular (CV) death, target lesion revascularization (TLR), and major adverse CV events (MACE).
Results:
Median follow-up was 494 days. Procedural success rates were similar between groups (98.1% vs. 99.0%). The MI group had a lower left ventricular ejection fraction, poorer renal function, and more often required intra-aortic balloon pump support. Periprocedural complications were similar between groups (15.4% vs. 13.0%). The MI group had higher all-cause mortality (32.7% vs. 16.0%, p = 0.018), early (6-month) TLR (6.5% vs. 0%, p = 0.012), and 6- and 12-month MACE rates (23.9% vs. 9.4%, p = 0.020; 19.2% vs. 2.9%, p = 0.006) than the non-MI group. After 1 year of follow-up, clinical outcomes were similar between groups. Multivariate analysis identified reduced ejection fraction as an independent predictor of mortality (p = 0.041). TLR-free survival was not significantly different in multivariate analysis.
Conclusions:
RA-assisted PCI is feasible and safe in MI patients, with similar procedural success and complication rates compared to non-MI patients. Impaired left ventricular function and poor renal function were predictors of 1-year all-cause mortality, but long-term TLR-free survival was not.
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