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Feasibility of rotational atherectomy in patients with acute coronary syndrome: favorable in-hospital outcomes and clinical importance of complexed coronary atherosclerosis

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Abstract

The feasibility of rotational atherectomy (RA) during percutaneous coronary intervention (PCI) in patients who present with acute coronary syndrome (ACS) remains fully unsettled. We retrospectively evaluated 198 consecutive patients who underwent RA during PCI from 2009 to 2020. All patients underwent intracoronary imaging (intravascular ultrasound 96.5%, optical coherence tomography 9.1%, both 5.6%) during PCI. Patients who underwent RA during PCI were divided into two groups: ACS (n = 49; unstable angina pectoris, n = 27; non-ST-elevation myocardial infarction, n = 18, and ST-elevation myocardial infarction, n = 4) and chronic coronary syndrome (CCS) (n = 149). The RA procedural success rate was comparable between in the ACS and CCS groups (93.9 vs. 89.9%, P = 0.41). No significant differences were observed in procedural complications and in-hospital death between the groups. The incidence of major adverse cardiovascular event (MACE) after 2 years was significantly higher in ACS group compared with CCS group (38.7 vs. 17.4%, log-rank P = 0.002). Multivariable Cox regression analysis identified SYNTAX score or CABG SYNTAX score > 22 (hazard ratio (HR) 2.66, 95% confidence interval (CI) 1.40–5.06, P = 0.002) and mechanical circulatory support during the procedure (HR 2.61, 95% CI 1.21–5.59, P = 0.013) as predictors of MACE at 2 years, but not ACS on index admission (HR 1.58, 95% CI 0.84–2.99, P = 0.151). RA procedure is feasible as a bail-out strategy for ACS lesions. However, more complexed coronary atherosclerosis and mechanical circulatory support during RA procedure, but no ACS lesions were associated with worse mid-term clinical outcomes.

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Acknowledgements

They are grateful for the technical support at the National Cerebral and Cardiovascular Center, especially Mrs. Yuko Yoshioka, Mr. Tomoyuki Kondo, Mr. Shintaro Kobayashi, and Mrs. Sayaka Watanabe.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Shuichi Yoneda, Yasuhide Asaumi, Kota Murai, Takamasa Iwai, Hideo Matama, Kenichiro Sawada, Hiroyuki Miura, Satoshi Honda, Masashi Fujino, Kensuke Takagi, Fumiyuki Otsuka, Yu Kataoka & Teruo Noguchi

  2. Department of Preventative Medicine, National Cerebral and Cardiovascular Center, Suita, Japan

    Kunihiro Nishimura

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  1. Shuichi Yoneda
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Correspondence to Shuichi Yoneda.

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Conflict of interest

Kota Murai has received honoraria from Abbott, TERUMO, Amgen, Bristol Myers Squibb, and Zeon Medical and support for attending meetings from OrbusNeich. Kensuke Takagi has received honoraria from Abbott, Edwards life sciences, and DAIICHI SANKYO. Fumiyuki Otsuka has received honoraria from Abbott, Amgen, Bayer, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Kowa, NIPRO, Novartis, Otsuka, Pfizer, Sanofi, Takeda, and TERUMO. Yu Kataoka has received research support from NIPRO and Abbott and honoraria from NIPRO, Abbott, Kowa, Amgen, Sanofi, Takeda, and Daiichi Sankyo. All other authors have nothing to disclose.

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Yoneda, S., Asaumi, Y., Murai, K. et al. Feasibility of rotational atherectomy in patients with acute coronary syndrome: favorable in-hospital outcomes and clinical importance of complexed coronary atherosclerosis. Heart Vessels 38, 1193–1204 (2023). https://doi.org/10.1007/s00380-023-02272-7

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