title: Planned versus provisional rotational atherectomy for severe calcified coronary lesions: Insights From the ROTATE multi-center registry.
abstract: OBJECTIVE
  We aimed to investigate procedural feasibility and outcomes associated with planned rotational atherectomy (RA) for severely calcified coronary lesions.
  
  
  BACKGROUND
  Limited data are available addressing the benefits of planned RA compared to provisional RA.
  
  
  METHODS
  Between 2002 and 2013, all patients with calcified lesions treated by RA were enrolled. Of these, patients treated with planned RA (358 patients) were compared to those treated with provisional RA (309 patients).
  
  
  RESULTS
  In-hospital major adverse cardiovascular events (MACE) were tended to be better in the planned RA group (unadjusted OR: 0.76; 95% CI: 0.44-1.31, P = 0.32, and adjusted OR: 0.59; 95% CI: 0.33-1.05, P = 0.07). The number of pre-dilation balloon catheters was significantly lower in the planned RA group (1.17 ± 0.60 vs. 1.47 ± 0.76, P < 0.001). Procedure time, fluoroscopy time, and contrast volume used were all significantly reduced in the planned RA group compared to the provisional RA group (procedure time; 65.2 ± 36.8min vs. 84.4 ± 43.1min, P < 0.001, fluoroscopy time; 33.1 ± 22.9min vs. 51.2 ± 29.6min, P < 0.001, and contrast volume; 232.9 ± 141.6ml vs. 302.9 ± 150.3ml, P < 0.001). The incidence of MACE at 1-year was significantly higher amongst the unadjusted population, whereas the difference was less marked between groups after propensity-score adjustment (unadjusted HR: 1.78; 95% CI: 1.16-2.74, P = 0.01, and adjusted HR: 1.44; 95% CI: 0.92-2.26, P = 0.11).
  
  
  CONCLUSIONS
  Planned RA appears to be safe and was associated with a reduction in procedural and fluoroscopy times, contrast volume, and the number of pre-dilation balloon catheters used. If there is a strong likelihood of requiring RA for the treatment of severely calcified lesions, operators should have a low threshold for adopting a planned RA strategy. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.|Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.|Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kawamoto
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.|Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.|Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.|Department of Cardiology, Imperial College, London, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Ruparelia
authors.affiliation: Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy.
authors.forename: Giacomo G
authors.initials: GG
authors.lastname: Boccuzzi
authors.affiliation: Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pennacchi
authors.affiliation: Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.affiliation: Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Garbo
authors.affiliation: Interventional Cardiology Unit, a.O. Ordine Mauriziano Umberto I, Turin, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.affiliation: Dipartimento Di Scienze Mediche, Divisione Di Cardiologia, Città Della Salute E Della Scienza, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Dipartimento Di Scienze Mediche, Divisione Di Cardiologia, Città Della Salute E Della Scienza, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Marco Luciano
authors.initials: ML
authors.lastname: Rossi
authors.affiliation: Division of Cardiology, Istituto Humanitas, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.affiliation: Department of Cardiology, Bolognini Hospital, Seriate, Bergamo, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Caroline
authors.initials: C
authors.lastname: Magri
authors.affiliation: Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.|Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D018592:Cross-Over Studies; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D061205:Vascular Calcification / Q000175:diagnosis / Q000601:surgery*
keywords: calcified lesions; percutaneous coronary intervention; rotational atherectomy