Rotational Atherectomy Evaluated in High-Risk PCI

June 1, 2014—In Catheterization and Cardiovascular Interventions, Mauricio G. Cohen, MD, et al published insights from an evaluation of rotational atherectomy (RA) outcomes in patients undergoing high-risk percutaneous coronary intervention (PCI), randomized to receive hemodynamic support using either intra-aortic balloon pump (IABP) or Impella 2.5 in the PROTECT II trial (2014;83:1057–1064).

The background of the study is that RA of heavily calcified lesions is often necessary for complex PCI but can be associated with slow-flow, hypotension, and higher risk of periprocedural myocardial infarction (MI).

As summarized in Catheterization and Cardiovascular Interventions, the investigators compared baseline, angiographic, procedural characteristics, and outcomes of patients treated with and without RA. Also, RA technique and outcomes were examined.

RA was used in 52 of 448 patients (32 with Impella vs 20 with IABP; P = .08). RA patients were older (72 vs 67 years; P = .0009), more likely to have previous coronary artery bypass graft surgery (48 vs 32%; P = .017), higher Society of Thoracic Surgeons score (8.1 vs 5.7; P = .012), and higher SYNTAX scores (37 vs 29; P < .0001).

The investigators reported that at 90 days, RA use was associated with a higher incidence of MI but no mortality difference. RA was used more aggressively with Impella resulting in higher rate of periprocedural MI (P < .01), with no difference in mortality between groups (P = .78). Repeat revascularization occurred less frequently with Impella (P < .001). There were no differences in 90-day major adverse events between IABP and Impella in patients undergoing RA (P = .29). In patients not treated with RA, fewer major adverse events were observed with Impella compared with IABP (P = .03).

The investigators concluded that patients who were treated with RA had more comorbidities, and more complex and extensive coronary artery disease. In patients with Impella, more aggressive RA use resulted in fewer revascularization events but a higher incidence of periprocedural MI.