Rotational Atherectomy In Coronary Heart Disease Patients with different
rotational speed:In hospital and Six-month Outcomes
Abstract
Objectives: To date, there is no consensus on optimal speed for
rotational atherectomy (RA) in patients with coronary heart disease
(CHD). Here, we aimed to investigate interventional outcomes of RA at
different rotational speeds and analyze its clinical effect in the
patients with CHD. Methods: A total of 372 CHD patients were
retrospectively analyzed between February 2017 and December 2021. The
patients received RA at different rotational speeds. The patients were
divided into four groups based on the maximum RA speed: group 1
(˂150,000rpm, 76 cases), group 2 (150,000rpm, 156 cases), group 3
(160,000rpm, 90 cases) and group 4 (≥170,000rpm, 50 cases). The
perioperative endpoints included hypotension, vasospasm, dissection,
slow flow, perforation, bradyarrhythmia, burr entrapment, rotawire
fracture during RA as well as the incidence of heart failure, stent
thrombosis, and cardiac death during hospitalization. Six-months
incidence of major cardiovascular and cerebrovascular events (MACCE)
such as a composite of myocardial infarction (MI), stent thrombosis,
target vessel revascularization (TVR), cardiogenic death, all-cause
death or stroke were the long-term primary endpoints. On the other hand,
long-term secondary endpoint was chronic heart failure.
Results: Our analysis showed that patients in group 4 had a
higher incidence of slow flow during the RA operation (P=0.025). There
was no significant difference in other complications among the four
groups. Besides, there was no significant difference in six-month MACCE
among the four groups (P=0.452). After adjusting for confounding
factors, increase in rotational speed led to a higher probability of
slow flow (P for non-linearity = 0.131; adjusted model) and MACCE (P for
non-linearity = 0.183; adjusted model). Logistic regression analysis
showed that rotational speed was a predictor of slow flow during RA
operation (OR=1.24, 95%CI:1.05~1.47, P=0.013), as well
as six-month incidence of MI (OR=2.22,
95%CI:1.04~4.71,p=0.038). Moreover, the analysis
demonstrated that a rotational speed of ˂150,000rpm was a predictor of
vasospasm during RA operation (OR=3.62, 95%
CI:1.21~10.8, P=0.021). Conclusion: Our
findings showed that CHD patients treated with RA at a rotational speed
of ≥170,000rpm had a higher risk of slow flow. In contrast, a rotational
speed of ˂150,000rpm was shown to be an independent risk factor for
spasm during RA in CHD patients. Moreover, rotational speed is an
independent risk factor for slow flow and six-month MI in CHD patients.
There was no significant difference in six-month outcomes in comparison
to elective CHD patients with different rotational speeds, and the
probability of MACCE was intensified with increase in rotational speed.