RoTational AThErectomy in acute coronary syndrome: Early and midterm outcomes from a multicentre registry

Mario Iannaccone, Fabio Piazza, Giacomo G. Boccuzzi, Fabrizio D'Ascenzo, Azeem Latib, Mauro Pennacchi, Marco Luciano Rossi, Fabrizio Ugo, Emanuele Meliga, Hiroyoshi Kawamoto, Claudio Moretti, Alfonso Ielasi, Roberto Garbo, Antonio H. Frangieh, David Hildick-Smith, Christian Templin, Antonio Colombo, Gennaro Sardella

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Aims: 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. Methods and 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.

Original languageEnglish (US)
Pages (from-to)1457-1464
Number of pages8
JournalEuroIntervention
Volume12
Issue number12
DOIs
StatePublished - Dec 2016
Externally publishedYes

Keywords

  • Acute coronary
  • Atherectomy
  • Calcified lesion
  • NSTE-ACS
  • Rotablator
  • Rotational
  • Syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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