TY - JOUR
T1 - RoTational AThErectomy in acute coronary syndrome
T2 - Early and midterm outcomes from a multicentre registry
AU - Iannaccone, Mario
AU - Piazza, Fabio
AU - Boccuzzi, Giacomo G.
AU - D'Ascenzo, Fabrizio
AU - Latib, Azeem
AU - Pennacchi, Mauro
AU - Rossi, Marco Luciano
AU - Ugo, Fabrizio
AU - Meliga, Emanuele
AU - Kawamoto, Hiroyoshi
AU - Moretti, Claudio
AU - Ielasi, Alfonso
AU - Garbo, Roberto
AU - Frangieh, Antonio H.
AU - Hildick-Smith, David
AU - Templin, Christian
AU - Colombo, Antonio
AU - Sardella, Gennaro
N1 - Publisher Copyright:
© Europa Digital & Publishing 2016. All rights reserved.
PY - 2016/12
Y1 - 2016/12
N2 - Aims: The safety and efficacy of rotational atherectomy (RA) in patients presenting with non-ST-elevation myocardial infarction (NSTE-ACS) remain to be defined. The aim of our study was to assess the safety and efficacy of RA in NSTE-ACS patients with reference to both short- and long-term follow-up. Methods and results: This was an observational retrospective registry which enrolled all consecutive patients undergoing RA, comparing patients with stable angina (SA) and NSTE-ACS. In addition, ACS patients were matched with those not undergoing RA. The primary endpoint was angiographic success. Procedural complications and in-hospital MACE were secondary endpoints along with MACE during follow-up. One thousand three hundred and eight patients were included: 37% (484) with an NSTE-ACS diagnosis and 63% (824) in the SA group. Angiographic success did not differ between the groups (98.8% vs. 99.2%, p=0.57). By univariate analysis procedural complications were more frequent in the NSTE-ACS group (11.3% vs. 8.0%, p=0.04). In-hospital MACE rates were comparable (5.7% vs. 5.8%, p=0.93); by multivariate analysis NSTE-ACS patients showed a non-significant trend towards a higher risk of adverse events (HR 2.39, CI: 0.96-5.96, p=0.061). MACE after a median of 27.9 months was significantly higher in the NSTE-ACS group compared with the SA group (32.4% vs. 24.2%, log-rank p<0.001), results confirmed by multivariate analysis. After propensity score matching, NSTE-ACS patients undergoing RA had similar outcomes to ACS patients who did not undergo RA (16% vs. 13%, log-rank p=0.14). Conclusions: Rotational atherectomy has similar safety and angiographic outcome in patients with NSTE-ACS or SA. The higher rate of adverse cardiac events at follow-up in NSTE-ACS patients undergoing RA is comparable with a matched population of NSTE-ACS patients not undergoing RA.
AB - Aims: The safety and efficacy of rotational atherectomy (RA) in patients presenting with non-ST-elevation myocardial infarction (NSTE-ACS) remain to be defined. The aim of our study was to assess the safety and efficacy of RA in NSTE-ACS patients with reference to both short- and long-term follow-up. Methods and results: This was an observational retrospective registry which enrolled all consecutive patients undergoing RA, comparing patients with stable angina (SA) and NSTE-ACS. In addition, ACS patients were matched with those not undergoing RA. The primary endpoint was angiographic success. Procedural complications and in-hospital MACE were secondary endpoints along with MACE during follow-up. One thousand three hundred and eight patients were included: 37% (484) with an NSTE-ACS diagnosis and 63% (824) in the SA group. Angiographic success did not differ between the groups (98.8% vs. 99.2%, p=0.57). By univariate analysis procedural complications were more frequent in the NSTE-ACS group (11.3% vs. 8.0%, p=0.04). In-hospital MACE rates were comparable (5.7% vs. 5.8%, p=0.93); by multivariate analysis NSTE-ACS patients showed a non-significant trend towards a higher risk of adverse events (HR 2.39, CI: 0.96-5.96, p=0.061). MACE after a median of 27.9 months was significantly higher in the NSTE-ACS group compared with the SA group (32.4% vs. 24.2%, log-rank p<0.001), results confirmed by multivariate analysis. After propensity score matching, NSTE-ACS patients undergoing RA had similar outcomes to ACS patients who did not undergo RA (16% vs. 13%, log-rank p=0.14). Conclusions: Rotational atherectomy has similar safety and angiographic outcome in patients with NSTE-ACS or SA. The higher rate of adverse cardiac events at follow-up in NSTE-ACS patients undergoing RA is comparable with a matched population of NSTE-ACS patients not undergoing RA.
KW - Acute coronary
KW - Atherectomy
KW - Calcified lesion
KW - NSTE-ACS
KW - Rotablator
KW - Rotational
KW - Syndrome
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U2 - 10.4244/EIJ-D-15-00485
DO - 10.4244/EIJ-D-15-00485
M3 - Article
C2 - 27998837
AN - SCOPUS:85006942249
SN - 1774-024X
VL - 12
SP - 1457
EP - 1464
JO - EuroIntervention
JF - EuroIntervention
IS - 12
ER -