Incidence and Determinants of Complications in Rotational Atherectomy

Abstract

Background— The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI). Methods and Results— The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02–1.05), impaired kidney function (OR 1.59, 95% CI 1.15–2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21–2.35), emergent PCI (OR 4.02, 95% CI 1.66–8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43–3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36–0.89). Conclusions— The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).

Feasibility and clinical outcomes of rotational atherectomy for heavily‐calcified side branches of complex coronary bifurcation lesions in the real‐world practice of the drug‐eluting stent era

“…Finally, our patients had more diabetes mellitus, higher levels of serum creatinine, and more multivessel diseases. These factors were negative contributors for long‐term outcomes of RA …”

Comparison of complications with a 1.25-mm versus a 1.5-mm burr for severely calcified lesions that could not be crossed by an intravascular ultrasound catheter

“…We reviewed 382 consecutive coronary lesions that were treated by RA in our institution during the period from November 2014 to April 2019. Indications for RA in our institution are the following: [1] angiographically moderate or severely calcified lesions, [2] diffuse lesions expected to be difficult to stent, and [3] ostial lesions [13,14]. We excluded 154 lesions in which pre-procedural IVUS was not attempted, and also excluded one lesion in which pre-procedural OCT was attempted but the OCT catheter could cross the lesion.…”

“…Although rotational atherectomy (RA) is a crucial device for severely calcified coronary lesions, severe complications such as type III perforation is more frequently observed in percutaneous coronary interventions (PCI) with than without RA [1,2]. Because intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) can provide additional information regarding calcification beyond angiography [3][4][5][6], the use of intravascular imaging devices may help operators to avoid serious complications during RA.…”

An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry

“…The J-PCI registry is an ongoing, prospective, multicenter Japanese nationwide registry of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), which was designed to record clinical backgrounds and outcomes of patients undergoing PCI. [19][20][21][22] Since 2013, it has been incorporated into the National Clinical Data system, which is a nationwide prospective web-based registration system. Each hospital has a data manager who is responsible for collecting PCI data and entering them into the online database.…”