Clinical predictors of mortality following rotational atherectomy and stent implantation in high-risk patients: A single center experience

• Published in: Catheterization and cardiovascular interventions 2015-10, Vol.86 (4), p.634-641
• Main Authors: Édes, István F., Ruzsa, Zoltán, Szabó, György, Nardai, Sándor, Becker, Dávid, Benke, Kálmán, Szilveszter, Bálint, Merkely, Béla
• Format: Article
• Language: English
• Subjects: acute coronary syndrome; Aged; Analysis of Variance; Atherectomy, Coronary - methods; Atherectomy, Coronary - mortality; Blood Vessel Prosthesis Implantation - methods; Blood Vessel Prosthesis Implantation - mortality; Cohort Studies; Combined Modality Therapy; Confidence Intervals; Coronary Angiography - methods; Coronary Artery Disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Drug-Eluting Stents; Female; Follow-Up Studies; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; percutaneous coronary intervention; percutaneous coronary revascularization; Predictive Value of Tests; Proportional Hazards Models; Registries; Retrospective Studies; Risk Assessment; Rotation; Severity of Illness Index; Survival Rate; Time Factors; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25945

Objectives Our aim was to assess the procedural success and determine the clinical predictors of postprocedure mortality, following rotational atherectomy (RA) and stenting in high‐risk patients. Background RA is mainly used to facilitate stenting in complex lesions. Outcomes involving RA and stenting have been investigated, yet high‐risk patients have not been adequately described. Methods Data of 218 consecutive patients who underwent RA were evaluated in a prospective register. Primary endpoints were the angiographic success and long‐term mortality. Secondary endpoints were procedural success, consumption of the angioplasty equipment, and periprocedural major adverse cardiac events. The impact of the relevant angiographic and clinical characteristics on long‐term mortality was analyzed using uni‐ and multivariate Cox regression analysis. Results Mean age of the patients was 70 ± 8.2 years, diabetes was present in 44%, and chronic renal failure in 29%. Prior myocardial infarction and three‐vessel disease amounted to 42.2% and 32.6%, respectively. Altogether, 52.8% of patients underwent RA after a failed, non‐RA intervention attempt, and 30.7% of cases presented as acute coronary syndromes. Angiographic success was 100%, and all patients received stents after RA. Periprocedural major adverse cardiac events occurred in five (2.3%) patients. Postprocedural death was investigated, with a mean follow‐up of 36 months. Mortality amounted to 37.2%. Multivariate analysis revealed that left ventricular ejection fraction