Bailout rotational atherectomy in patients with myocardial infarction is not associated with an increased periprocedural complication rate or poorer angiographic outcomes in comparison to elective procedures (from the ORPKI Polish National Registry 2015–2016)

Abstract

IntroductionMany years of experience and refinement of existing rotational atherectomy (RA) techniques have resulted in improved clinical outcomes and a tendency to broaden the spectrum of RA usage.AimTo compare the angiographic effectiveness and periprocedural complications in patients with stable angina (SA) and acute myocardial infarction (AMI) treated using RA.Material and methodsData were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all percutaneous coronary interventions (PCIs) performed in Poland in 2015 and 2016. In total, 975 RA procedures were recorded out of 221,187 PCI procedures.ResultsWe compared angiographic effectiveness and periprocedural complications in 530 patients with SA and 245 with AMI in the RA group of patients, and 60,522 patients with SA and 91,985 with AMI in the non-RA group. The overall rate of periprocedural complications did not differ between SA and AMI patients in the RA group (2.3% vs. 2.0%; p = 0.84), while it was lower in AMI patients from the RA group compared to those from the non-RA group (2.0% vs. 3.0%; p = 0.34). The percentage of patients with angiographic success in the RA group was similar to the non-RA group in SA patients (97.3% vs. 97.1%; p = 0.75), whereas in the AMI group it was significantly higher compared to the non-RA group (96.7% vs. 92.6%; p < 0.001).ConclusionsThe angiographic effectiveness of PCI with RA in patients with AMI was not worse than in patients with SA.

Current trends and procedural outcomes in the era of rotational atherectomy expansion in Poland in the period 2014–2017 (based on the nationwide ORPKI registry)

“…That is why their percentages were higher compared to our study [12, 13]. However, one may have reservations about the low frequency and underestimation of the number of procedure-related complications, but in the case of analysis among large groups of patients, it is assumed that certain trends do not change significantly and reflect real life [14].…”

Radial Approach Expertise and Clinical Outcomes of Percutanous Coronary Interventions Performed Using Femoral Approach

“…A detailed description of the ORPKI national PCI registry was presented previously [7,11,12,13,14]. Briefly, the ORPKI is an electronic database on all percutaneous procedures in interventional cardiology centers performed in Poland and is currently operated by the Jagiellonian University Medical College in Krakow.…”

Severely calcified coronary stenoses: novel challenges, old remedy

“…Nevertheless, RA has remained largely underused, representing 1 to 5% of the total PCI volume [ 1 ]. Possible reasons for this limited adoption include underestimation of calcification in coronary angiography, perceived complexity of the technique and potential RA-related complications, which are mentioned in the two recent observational analyses published in this issue of the journal [ 5 , 6 ].…”

“…In the ORPKI Polish National dataset [ 6 ], 245 patients with ST-elevated myocardial infarction (STEMI) or non-ST-elevated myocardial infarction (NSTEMI) treated with RA between 2015 and 2016 were compared with 91,985 contemporary patients treated without RA. As expected, patients treated with RA had a higher rate of complex coronary disease such as left main stenosis or multivessel disease.…”