title: Clinical predictors of mortality following rotational atherectomy and stent implantation in high-risk patients: A single center experience.
abstract: OBJECTIVE
  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.
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor street 68, 1122, Budapest, Hungary.
authors.forename: István F
authors.initials: IF
authors.lastname: Édes
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor street 68, 1122, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Ruzsa
authors.affiliation: György Gottsegen National Institute of Cardiology, Haller steet 29, 1096, Budapest, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Szabó
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor street 68, 1122, Budapest, Hungary.
authors.forename: Sándor
authors.initials: S
authors.lastname: Nardai
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor street 68, 1122, Budapest, Hungary.
authors.forename: Dávid
authors.initials: D
authors.lastname: Becker
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor street 68, 1122, Budapest, Hungary.
authors.forename: Kálmán
authors.initials: K
authors.lastname: Benke
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor street 68, 1122, Budapest, Hungary.
authors.forename: Bálint
authors.initials: B
authors.lastname: Szilveszter
authors.affiliation: Semmelweis University Heart and Vascular Center, Városmajor street 68, 1122, Budapest, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017225:Atherectomy, Coronary / Q000379:methods / Q000401:mortality*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012399:Rotation; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute coronary syndrome; coronary artery disease; percutaneous coronary intervention; percutaneous coronary revascularization