title: ROTational AThErectomy in acute coronary syndrome: early and midterm outcomes from a multicentre registry.
abstract: OBJECTIVE
  The safety and efficacy of rotational atherectomy (RA) in patients presenting with non-ST-elevation myocardial infarction (NSTE-ACS) remain to be defined. The aim of our study was to assess the safety and efficacy of RA in NSTE-ACS patients with reference to both short- and long-term follow-up.
  
  
  RESULTS
  This was an observational retrospective registry which enrolled all consecutive patients undergoing RA, comparing patients with stable angina (SA) and NSTE-ACS. In addition, ACS patients were matched with those not undergoing RA. The primary endpoint was angiographic success. Procedural complications and in-hospital MACE were secondary endpoints along with MACE during follow-up. One thousand three hundred and eight patients were included: 37% (484) with an NSTE-ACS diagnosis and 63% (824) in the SA group. Angiographic success did not differ between the groups (98.8% vs. 99.2%, p=0.57). By univariate analysis procedural complications were more frequent in the NSTE-ACS group (11.3% vs. 8.0%, p=0.04). In-hospital MACE rates were comparable (5.7% vs. 5.8%, p=0.93); by multivariate analysis NSTE-ACS patients showed a non-significant trend towards a higher risk of adverse events (HR 2.39, CI: 0.96-5.96, p=0.061). MACE after a median of 27.9 months was significantly higher in the NSTE-ACS group compared with the SA group (32.4% vs. 24.2%, log-rank p<0.001), results confirmed by multivariate analysis. After propensity score matching, NSTE-ACS patients undergoing RA had similar outcomes to ACS patients who did not undergo RA (16% vs. 13%, log-rank p=0.14).
  
  
  CONCLUSIONS
  Rotational atherectomy has similar safety and angiographic outcome in patients with NSTE-ACS or SA. The higher rate of adverse cardiac events at follow-up in NSTE-ACS patients undergoing RA is comparable with a matched population of NSTE-ACS patients not undergoing RA.
authors.affiliation: "Città della Scienza e della Salute", University of Turin, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Iannaccone
authors.forename: Fabio
authors.initials: F
authors.lastname: Piazza
authors.forename: Giacomo G
authors.initials: GG
authors.lastname: Boccuzzi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Mauro
authors.initials: M
authors.lastname: Pennacchi
authors.forename: Marco Luciano
authors.initials: ML
authors.lastname: Rossi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ugo
authors.forename: Emanuele
authors.initials: E
authors.lastname: Meliga
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.forename: Roberto
authors.initials: R
authors.lastname: Garbo
authors.forename: Antonio H
authors.initials: AH
authors.lastname: Frangieh
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome