ROTATE Registry Compares Planned Versus Provisional Rotational Atherectomy

January 28, 2016—Hiroyoshi Kawamoto, MD, et al published findings from the ROTATE multicenter registry of planned versus provisional rotational atherectomy (RA) for severe calcified coronary lesions in Catheterization and Cardiovascular Interventions. The investigators aimed to investigate procedural feasibility and outcomes associated with planned RA for severely calcified coronary lesions. 

The investigators concluded that planned RA appears to be safe and was associated with a reduction in procedural and fluoroscopy times, contrast volume, and the number of predilation balloon catheters used. They advised that if there is a strong likelihood of requiring RA for the treatment of severely calcified lesions, operators should have a low threshold for adopting a planned RA strategy.

In the study, all patients with calcified lesions treated by RA were enrolled between 2002 and 2013. Those patients treated with planned RA (358 patients) were compared to those treated with provisional RA (309 patients).

As summarized in Catheterization and Cardiovascular Interventions, rates of in-hospital major adverse cardiovascular events (MACE) tended to be better in the planned RA group (unadjusted odds ratio [OR], 0.76; 95% confidence interval [CI], 0.44–1.31; P = .32; adjusted OR, 0.59; 95% CI, 0.33–1.05; P = .07).

The investigators found that the number of predilation balloon catheters was significantly lower in the planned RA group (1.17 ± 0.6 vs 1.47 ± 0.76; P < .001). Procedure time, fluoroscopy time, and contrast volume used were all significantly reduced in the planned RA group compared to the provisional RA group (procedure time: 65.2 ± 36.8 minutes vs 84.4 ± 43.1 minutes; P < .001; fluoroscopy time: 33.1 ± 22.9 minutes vs 51.2 ± 29.6 minutes; P < .001; and contrast volume: 232.9 ± 141.6 ml vs 302.9 ± 150.3 ml; P < .001). The incidence of MACE at 1-year was significantly higher among the unadjusted population, but the difference was less marked between groups after propensity-score adjustment (unadjusted hazard ratio [HR], 1.78; 95% CI, 1.16–2.74; P = .01, and adjusted HR, 1.44; 95% CI, 0.92–2.26; P = .11), reported the investigators.