title: Optimizing rotational atherectomy in high-risk percutaneous coronary interventions: insights from the PROTECT ΙΙ study.
abstract: OBJECTIVE
  To study rotational atherectomy (RA) outcomes in patients undergoing high-risk PCI randomized to receive hemodynamic support using either IABP or Impella 2.5 in the PROTECT II trial.
  
  
  BACKGROUND
  RA of heavily calcified lesions is often necessary for complex PCI but can be associated with slow-flow, hypotension, and higher risk of periprocedural MI.
  
  
  METHODS
  We compared baseline, angiographic, procedural characteristics, and outcomes of patients treated with and without RA. We examined also RA technique and outcomes.
  
  
  RESULTS
  RA was used in 52 of 448 patients (32 with Impella vs 20 with IABP, P = 0.08). RA patients were older (72 vs. 67 yo, P = 0.0009), more likely to have prior CABG (48 vs. 32%, P = 0.017), higher STS (8.1 vs. 5.7, P = 0.012) and higher SYNTAX scores (37 vs. 29, P < 0.0001). At 90 days, RA use was associated with higher incidence of MI but no mortality difference. RA was used more aggressively with Impella resulting in higher rate of periprocedural MI (P < 0.01), with no difference in mortality between groups (P = 0.78). Repeat revascularization occurred less frequently with Impella (P < 0.001). There were no differences in 90-day major adverse events between IABP and Impella in patients undergoing RA (P = 0.29). In patients not treated with RA, fewer MAEs were observed with Impella compared with IABP (P = 0.03).
  
  
  CONCLUSIONS
  Patients who were treated with RA had more comorbidities, and more complex and extensive coronary artery disease. In patients with Impella, more aggressive RA use resulted in fewer revascularization events but higher incidence of periprocedural MI.
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.forename: Abhijit
authors.initials: A
authors.lastname: Ghatak
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Srihari S
authors.initials: SS
authors.lastname: Naidu
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Massaro
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moses
authors.forename: E
authors.initials: E
authors.lastname: Magnus Ohman
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.forename: Alan W
authors.initials: AW
authors.lastname: Heldman
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: atherectomy; percutaneous coronary intervention; ventricular support device