Temporal Trends and Prognosis in Rotational Atherectomy: A Comparison of Contemporary and Traditional Eras

Rotational atherectomy (RA) has undergone considerable technical modernization in recent years. This study evaluated whether RA performed in the contemporary era was associated with superior cardiovascular outcomes compared with the traditional era.

To compare the clinical characteristics and cardiovascular outcomes of patients treated with contemporary versus traditional rotational atherectomy, reflecting the evolution of clinical practice over time.

We employed a registry including patients from April 2004 to December 2020. Group allocation was determined through a cluster analysis based on three variables reflecting temporal changes in RA practice: vascular access, sheath size, and burr diameter, yielding a traditional cohort (n = 290; procedures before May 2011) and a contemporary cohort (n = 279; procedures from May 2011). Comparisons between groups were performed to assess for statistically and clinically relevant prognostic differences. Multivariable analyses were performed to adjust for baseline imbalances.

Patients treated in the contemporary cohort exhibited lower left ventricular ejection fraction (LVEF) and worse Killip class. Their RA procedures were longer, required less contrast, and made substantially greater use of intracoronary imaging than those in the traditional cohort. Statin therapy and potent P2Y₁₂ inhibitors were prescribed more frequently in the contemporary cohort. On follow-up, contemporary practice yielded fewer reinfarctions and fewer target-lesion and target-vessel revascularizations, but a higher incidence of clinically relevant bleeding. Cardiovascular and all-cause mortality were comparable between both eras. These differences persisted after multivariable adjustment for baseline imbalances.

Contemporary RA was associated with fewer reinfarctions and revascularizations, which persisted after multivariable adjustment. Despite including patients with lower LVEF and a more critical status, no differences were detected in all-cause mortality.