title: Drug-eluting stent use after coronary atherectomy: results from a multicentre experience - The ROTALINK I study.
abstract: OBJECTIVE
  Until now, there is no medium- to long-term clinical evidence of the best treatment after rotational atherectomy.
  
  
  METHODS
  From the databases of seven high-volume centres, years 2005-2010, we retrospectively analysed the long-term outcome of patients who had undergone rotational atherectomy followed by plain-balloon angioplasty or implantation of drug-eluting stent (DES) or bare metal stent (BMS). Primary endpoint was the incidence of major adverse cardiovascular events (MACE: death, myocardial infarction, target-lesion-revascularization) at longest available follow-up.
  
  
  RESULTS
  In this registry, we enrolled 1397 patients with 1605 lesions, followed for 28.4 ± 21 months. DES-treated patients were more frequently diabetic, had more lesions treated and received a higher number of stents. In-hospital MACEs were significantly higher in DES patients (7.6 vs. 2.6 vs. 2.9%, respectively, P = 0.0001 for both), mainly due to a higher incidence of myocardial infarction (6.4 vs. 1.2 vs. 2.1%, P = 0.0001). The 2-year follow-up showed a significantly lower incidence of MACE in DES patients (15.1 vs. 24.2 vs. 20.8%, P = 0.001 for both), driven by a lower incidence of target-lesion revascularization (8 vs. 14.6 vs. 13.9%, P = 0.002). Myocardial infarction rate was lower in the DES group as well (0.4 vs. 3.1% in BMS, P = 0.001). At multivariate analysis, BMS implantation and balloon angioplasty were independent predictors of long-term MACE. DES implantation was associated with a lower risk of long-term myocardial infarction [hazard ratio 0.15, 95% confidence interval (95% CI) 0.04-0.67] and target-lesion revascularization (hazard ratio 0.42, 95% CI 0.21-0.82). Male sex and DES use were independent predictors of the absence of MACE.
  
  
  CONCLUSIONS
  After rotational atherectomy, DES implantation appears to be a preferable strategy, as it is associated with lower long-term MACE, despite an unexpected increase in periprocedural myocardial infarction.
authors.affiliation: aUnit of Interventional Cardiology, A.O. Fatebenefratelli, Milan bDepartment of Interventional Cardiology, Ospedale Mauriziano Umberto I, Torino cDepartment of Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan dDepartment of Interventional Cardiology, Spedali Civili, Brescia eDepartment of Interventional Cardiology, Cliniche Humanitas, Milan fDepartment of Interventional Cardiology, Ospedale Moriggia-Pelascini, Gravedona, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.forename: Tiziana C
authors.initials: TC
authors.lastname: Aranzulla
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Giuliano
authors.initials: G
authors.lastname: Chizzola
authors.forename: Dennis
authors.initials: D
authors.lastname: Zavalloni
authors.forename: Emanuela
authors.initials: E
authors.lastname: Tavasci
authors.forename: Mauro
authors.initials: M
authors.lastname: De Benedictis
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000379:methods*; D057186:Comparative Effectiveness Research / Q000379:methods; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome