Clinical predictors of mortality following rotational atherectomy and stent implantation in high-risk patients: A single center experience

• Published in: Catheterization and cardiovascular interventions Vol. 86; no. 4; pp. 634 - 641
• Main Authors: Édes, István F., Ruzsa, Zoltán, Szabó, György, Nardai, Sándor, Becker, Dávid, Benke, Kálmán, Szilveszter, Bálint, Merkely, Béla
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-10-2015; Wiley Subscription Services, Inc; John Wiley and Sons Inc
• Subjects: acute coronary syndrome; Aged; Analysis of Variance; Atherectomy, Coronary - methods; Atherectomy, Coronary - mortality; Blood Vessel Prosthesis Implantation - methods; Blood Vessel Prosthesis Implantation - mortality; Cohort Studies; Combined Modality Therapy; Confidence Intervals; Coronary Angiography - methods; Coronary Artery Disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Drug-Eluting Stents; Female; Follow-Up Studies; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; percutaneous coronary intervention; percutaneous coronary revascularization; Predictive Value of Tests; Proportional Hazards Models; Registries; Retrospective Studies; Risk Assessment; Rotation; Severity of Illness Index; Survival Rate; Time Factors; Treatment Outcome; coronary artery disease; percutaneous coronary intervention; acute coronary syndrome; percutaneous coronary revascularization
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25945

Objectives
Our aim was to assess the procedural success and determine the clinical predictors of postprocedure mortality, following rotational atherectomy (RA) and stenting in high‐risk patients.
Background
RA is mainly used to facilitate stenting in complex lesions. Outcomes involving RA and stenting have been investigated, yet high‐risk patients have not been adequately described.
Methods
Data of 218 consecutive patients who underwent RA were evaluated in a prospective register. Primary endpoints were the angiographic success and long‐term mortality. Secondary endpoints were procedural success, consumption of the angioplasty equipment, and periprocedural major adverse cardiac events. The impact of the relevant angiographic and clinical characteristics on long‐term mortality was analyzed using uni‐ and multivariate Cox regression analysis.
Results
Mean age of the patients was 70 ± 8.2 years, diabetes was present in 44%, and chronic renal failure in 29%. Prior myocardial infarction and three‐vessel disease amounted to 42.2% and 32.6%, respectively. Altogether, 52.8% of patients underwent RA after a failed, non‐RA intervention attempt, and 30.7% of cases presented as acute coronary syndromes. Angiographic success was 100%, and all patients received stents after RA. Periprocedural major adverse cardiac events occurred in five (2.3%) patients. Postprocedural death was investigated, with a mean follow‐up of 36 months. Mortality amounted to 37.2%. Multivariate analysis revealed that left ventricular ejection fraction < 50%, glomerular filtration rate < 60 ml/min, cardiogenic shock, and diabetes were the only independent mortality predictors.
Conclusions
We have found that RA and stenting is feasible and viable in an elderly high‐risk population, with exceptional procedural success and acceptable long‐term results. © 2015 Wiley Periodicals, Inc.