Abstract
Objectives: To retrospectively review the short term outcomes of rotational atherectomy in a high CathPCI Risk and high Syntax Population. Methodology: A total of 51 patients who underwent RA between 1st June 2017 and 31st April 2019 were retrospectively reviewed after approval from ethical review committee. Clinical follow up was obtained for procedural success and major adverse cardiovascular events (MACE) at 3 months. Results: Patients who underwent RA were high risk with a mean Syntax score 32.7±5.9 and mean NCDR CathPCI risk score of 51.1±13. The mean age of the patients were 70 years, majority were males (81%), type 2 diabetics (78%) with chronic kidney disease (52.7%), Non-ST elevated myocardial infarction (NSTEMI) (35%) and Syntax Score>32 (64.8%). Out of 37 individuals, procedural success was reported in all subjects except one in the high risk syntax group. At three months, MACE was reported in 4 patients. Out of these four, one was intra-procedural death, three had repeat myocardial infarction. Out of these three, two declined repeat revascularization and were managed medically. One patient died during admission despite repeat revascularization. Almost all MACE reported, occurred in patients with Syntax>32. Conclusion: Despite high risk Syntax and CathPCI scores, RA led to high immediate procedural success for PCI in calcified lesions at our hospital with infrequent MACE.
Highlights
Coronary artery calcification (CAC) is a common finding on angiogram that increases the complexity of percutaneous coronary interventions (PCI).[1]
Evidence from ROTAXUS (Rotational Atherectomy Prior to TAXUS Stent Treatment for Complex Native Coronary Artery Disease) study performed in mainly Caucasian patients showed that despite high immediate success (92%), there was no effect of rotational atherectomy on late lumen loss and recurrent cardiac events
G Minocha et al reported a procedural success rate of 99% in Indian patients with major adverse cardiovascular events (MACE) reported in 8% patients whereas Baruah DK et al concluded in Indian patients that the procedural success rates approached 97.8% and MACE was 8%.This is much lower than the MACE rate of 28% at 9 months and 29% at 2 years reported by ROTAXUS
Summary
Coronary artery calcification (CAC) is a common finding on angiogram that increases the complexity of percutaneous coronary interventions (PCI).[1]. Around 90% of males over the age of 70 years have CAC.[3] A recent retrospective analysis of a large multiethnic cohort undergoing PCI with drug eluting stents concluded that CAC remained an independent predictor of post PCI complications.[4] In this study major adverse cardiovascular events (MACE) among patients with none/mild, moderate, and severe calcification were 8.3, 14.6, and 17.8%, respectively.[4] Mechanical debulking of lesions with rotational atherectomy (RA) is essential in managing these calcified lesions.[5,6] RA involves differential sanding of calcified coronary plaques with the use of diamond tip rotablator device (Boston Scientific, USA) that is advanced over a guide wire at 140,000 to 180,000 revolutions per minute.[7] Evidence of RA from the US and Europe is extensive, little has been published from lower middle income countries (LMIC). This study is an effort to put forward our experience of RA assisted PCI
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