Cardiovascular Outcomes Following Rotational Atherectomy: A UK Multicentre Experience.
OBJECTIVE
To identify factors associated with outcomes following rotational atherectomy (RA).


BACKGROUND
RA is an effective way to mechanically modify heavily calcified lesions before stenting; however its outcomes are not well defined.


RESULTS
Retrospective evaluation of all patients who underwent RA in three large UK centers (Leeds General Infirmary (LGI), Royal Infirmary of Edinburgh (RIE) and University Hospital of North Staffordshire (UHNS)) from March 2005 to January 2013. Five hundred and eighteen patients had RA with median follow-up period of 22 months. About 68.3% were male, 28.7% had DM and 34.6% were treated because of ACS. Stents were deployed in 97.3% of the patients while 30.7% of the procedures were performed transradially. Maximum burr was ≤1.75 mm in 85.5% and the mean SYNTAX score was 19.5 ± 11.6. Peri-procedural complications occurred in 6.4% and vascular access complications in 1.9%. Outcomes in the follow-up period were: MACE 17.8%, cardiac death 7.1%, MI 11.7%, TVR 7.5%, all-cause death 13.7%, definite stent thrombosis (ST) 1.4% and stroke 2.9%. Patients with intermediate and high SYNTAX scores were more likely to suffer MACE, cardiac death, MI, all-cause death and ST. Patients with a SYNTAX score >32 were also more likely to have a peri-procedural complication. Multiple logistic regression analysis showed that the presence of PVD (P = 0.026, OR = 2.0), DM (P = 0.008, OR = 2.1), ACS presentation (P = 0.011, OR = 2.1) and SYNTAX score ≥23 (P = 0.02, OR = 1.9) had a significant association with MACE.


CONCLUSIONS
RA is safe and effective, with high rate of procedural success and relatively low incidence of MACE. PVD, DM, ACS presentation and SYNTAX score were significant predictors for MACE. © 2016 Wiley Periodicals, Inc.
Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.
Christos
C
Eftychiou
Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.
David S
DS
Barmby
Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Simon J
SJ
Wilson
Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
Salahaddin
S
Ubaid
Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
Andrew J
AJ
Markwick
Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.
Loukia
L
Makri
Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.
Jonathan M
JM
Blaxill
Department of Cardiology, Forth Valley Royal, Edinburgh, United Kingdom.
James C
JC
Spratt
Department of Cardiology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
Mark
M
Gunning
Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom. j.greenwood@leeds.ac.uk.|Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom. j.greenwood@leeds.ac.uk.
John P
JP
Greenwood
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology; D013812:Therapeutics; D013997:Time Factors; D006113:United Kingdom; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*
atherectomy; coronary artery disease; directional/rotational; percutaneous coronary intervention