[In-hospital major complications associated with rotational atherectomy: experience with 800 patients at a single center].
BACKGROUND
Rotational atherectomy is usually performed in patients with angiographically determined high risk coronary lesions. The aim of this study was to evaluate the rate of major adverse cardiac events (death, Q-wave infarction or new revascularization) after rotational atherectomy, as well as to identify the clinical characteristics associated with this incidence.


METHODS
The study population included 800 patients treated with rotational atherectomy from 1993 to 1999: 512 (64%), for de novo lesions, and 288 (36%) for restenosis. Balloon dilation and coronary stenting was performed in 95% and 34% of patients, respectively.


RESULTS
During hospitalization, 17 patients (2.1%) died, 16 (2%) had a Q-wave infarction, 30 (3.8%) a non-Q infarction, and new revascularization was performed in 28 (3.5%). The incidence of major adverse cardiac events was 6.5% (n = 52), this incidence being higher in the presence of diabetes (8.9 vs. 4.4%; p = 0.01), unstable angina or acute/recent myocardial infarction (7.6 vs. 3.3%; p = 0.02), multivessel disease (8.6 vs. 3.3%; p < 0.01), treated vessel other than right coronary (7.0 vs. 1.7%; p = 0.01), procedure in > 1 vessel (10.7 vs. 4.7%; p < 0.01), angiographic failure (62.5 vs. 5.5%; p < 0.001), and de novo lesions (8.4 vs. 2.5%; p < 0.01), with diabetes and treatment of de novo lesions being independent predictors of major adverse cardiac events. However, age, previous infarction, and left ventricular dysfunction, were not associated with the rate of events.


CONCLUSIONS
Some simple variables are associated with a higher incidence of major adverse cardiac events after rotational atherectomy. Advanced age, previous infarction and left ventricular dysfunction, however, do not necessarily imply a poorer prognosis in these patients.
Moreno
R
R
Servicio de Cardiología, Hospital Gregorio Marañón, Madrid.
García
E
E
Pérez de Isla
L
L
Acosta
J
J
Abeytua
M
M
Soriano
J
J
López-Sendón
J L
JL
D000368:Aged; D017225:Atherectomy, Coronary / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis