title: Utility of rotational atherectomy and outcomes over an eight-year period.
abstract: OBJECTIVE
  To evaluate outcomes of patients undergoing rotational atherectomy (RA) in a multicenter percutaneous coronary intervention (PCI) registry.
  
  
  BACKGROUND
  RA remains an important technique for plaque modification in PCI, particularly with complex calcification.
  
  
  METHODS
  The study population consisted of consecutive patients undergoing PCI in nine major Australian hospitals, who were treated over an 8-year period (June 2004 to June 2012).
  
  
  RESULTS
  Of 16,577 PCI's, 1.0% of patients n = 167 (214 lesions) underwent RA. Patients undergoing RA were more likely to be older (71.0 ± 9.7 vs. 64.4 ±11.9 years, P < 0.01), with greater incidence of diabetes (37.7% vs. 23.8%, P < 0.01) and renal impairment. There was no significant difference in procedural success (94.6% vs. 95.5%, P = 0.57), dissection (6.1% vs. 4.8%, P = 0.39), transient no reflow (4.4% vs. 2.8%, P = 0.23), or persistent no reflow (0% RA vs. 0.7% non-RA, P = 0.23). Those undergoing RA had a low but increased risk of death at 12 months (6.6 vs. 3.6%, P = 0.04). There was no significant difference in 12 month major adverse cardiovascular outcomes (MACE) between groups following adjustment for univariate predictors (OR 1.00, 95%CI; 0.93-1.08). Additionally, there was no significant difference in 30-day MACE (6.0% vs. 5.1%, P = 0.62) or 30-day mortality (2.4% vs. 1.8%, P = 0.54) between groups.
  
  
  CONCLUSIONS
  In this large multicenter registry, RA continues to be used to treat complex lesions with low procedural complications and MACE rates. It is essential for interventional cardiologists to maintain skills in RA to enable effective percutaneous treatment of certain complex lesions.
authors.affiliation: Department of Cardiology, The Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Lachlan T
authors.initials: LT
authors.lastname: Couper
authors.affiliation: Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: Loane
authors.affiliation: Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Brennan
authors.affiliation: Department of Cardiology, The Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Nanayakkara
authors.affiliation: Department of Cardiology, The Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Nerlekar
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Scott
authors.affiliation: Department of Cardiology, The Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Walton
authors.affiliation: Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.affiliation: Department of Cardiology, The Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.|Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
authors.affiliation: Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.affiliation: Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Reid
authors.affiliation: Department of Cardiology, The Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
authors.forename: James A
authors.initials: JA
authors.lastname: Shaw
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D001315:Australia; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012399:Rotation; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: angiography; coronary; percutaneous coronary intervention