title: Contemporary clinical outcomes of patients treated with or without rotational coronary atherectomy--an analysis of the UK central cardiac audit database.
abstract: BACKGROUND
  Rotational atherectomy (RA) is widely used for treating calcified coronary lesions. Clinical data however remain limited.
  
  
  METHODS
  We assessed outcome and survival among patients undergoing percutaneous coronary intervention (PCI) with or without RA in the UK between September 2007 and March 2011.
  
  
  RESULTS
  Data from 221,669 percutaneous coronary intervention (PCI) procedures were analysed; 2152 patients (0.97%) underwent RA (RA+); the remainder underwent conventional PCI (RA-). RA+ patients were older (71.7±9.6 vs. 64.1±12.8 year; p<0.001), and had a higher incidence of diabetes (26.4% vs. 18.0%; p<0.001), hypertension, (61.9% vs. 49.4%; p<0.001), peripheral vascular disease (9.9% vs. 4.2%, p<0.001), cerebrovascular disease (5.5% vs. 3.4%, p<0.001), renal impairment (3.4% vs. 1.5%, p<0.001) and poor left ventricular function (11.4% vs. 4.3%,p<0.001). Procedural success was lower among RA+ patients (90.3% vs 94.6%; p<0.001) and procedural complications were more frequent (9.7% vs 5.4%; p<0.001). After 2.4±1.2 years follow-up, unadjusted Cox proportional hazard modeling demonstrated poorer survival for RA+ patients (HR 2.21, 95%CI 1.97-2.49; p<0.0001). This disadvantage remained after adjustment for adverse variables (HR 1.26, 95%CI 1.11-1.44; p=0.0004) and following propensity analysis. There was evidence however of improved survival for RA+ patients with left main stem disease (HR 0.52, 95%CI 0.35-0.75, p<0.0001), and peripheral vascular disease (HR 0.65, 95%CI 0.43-0.98, p<0.0005).
  
  
  CONCLUSIONS
  Rotational atherectomy was undertaken in patients with higher pre-procedural risk. Medium term survival was worse among patients undergoing rotational atherectomy, and this survival disadvantage remained after correction for available adverse factors. Rotational atherectomy however remains clinically useful for patients with calcified coronary lesions.
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. Electronic address: jacockburn@hotmail.com.
authors.forename: James
authors.initials: J
authors.lastname: Cockburn
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.affiliation: Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
authors.forename: James
authors.initials: J
authors.lastname: Cotton
authors.affiliation: Queen Elizabeth Hospital NHS Trust, Birmingham, UK.
authors.forename: Sagar
authors.initials: S
authors.lastname: Doshi
authors.affiliation: Belfast NHS Trust, Belfast, UK.
authors.forename: Colm
authors.initials: C
authors.lastname: Hanratty
authors.affiliation: Queen Elizabeth Hospital NHS Trust, Birmingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Department of Mathematics, Sussex University, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Robinson
authors.affiliation: King's Health Partners, Rayne Institute, St Thomas' Campus, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.affiliation: The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: de Belder
authors.affiliation: Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK. Electronic address: adam.debelder@bsuh.nhs.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D061205:Vascular Calcification / Q000401:mortality* / Q000628:therapy*
keywords: Outcomes; Percutaneous coronary intervention; Rotational atherectomy