AUTHOR=Chen Yu-Wei , Lai Chih-Hung , Su Chieh-Shou , Chang Wei-Chun , Wang Chi-Yen , Chen Wei-Jhong , Lin Tzu-Hsiang , Liang Kae-Woei , Liu Tsun-Jui , Lee Wen-Lieng 

TITLE=The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.846564

DOI=10.3389/fcvm.2022.846564

ISSN=2297-055X

ABSTRACT=Background: Rotational atherectomy (RA) is an indispensable tool for calcified lesion preparation in percutaneous coronary intervention (PCI). However, use of RA in the setting of acute myocardial infarction (AMI) is challenged with limited clinical data.
Objectives: This study aims to retrospectively investigate the procedure results, periprocedural complications and clinical outcomes of RA in patients presenting with AMI.
Methods: All possible consecutive patients who received RA in AMI from January 2009 to March 2018 in single tertiary center were analyzed retrospectively. Patients presenting with non-AMI during the study period were also enrolled for comparison.
Results: A total of 121 AMI patients (76.0 ± 10.8 years old, 63.6% male) and 290 non-AMI patients were recruited. Among the AMI group, 81% of patients had NSTEMI and 14% presented with cardiogenic shock. RA could be completed in 98.8% of patients in the AMI group and 98.3% in the non-AMI group (p = 1.00). The periprocedural complication rates were comparable between AMI and non-AMI groups. The risks of in-hospital, 30-day, 90-day and one-year CV MACE were significantly higher in the AMI group compared with the non-AMI group (in-hospital 13.2 % vs. 2.8%, p < 0.001; 30-day 14.2 % vs. 4.5%, p < 0.001; 90-day 20.8 % vs. 6.9%, p < 0.001; one-year 30.8% vs. 19.1%, p= 0.01). AMI at initial presentation and cardiogenic shock were predictors for both in-hospital CV MACE and one-year CV MACE in multivariable binary logistic regression analysis. Other predictors for one-year CV MACE included serum creatinine level and triple vessel disease.
Conclusions: RA in patients presenting with AMI is feasible with high procedural completion rate and acceptable peri-procedural complications. Given unstable hemodynamics and complex coronary anatomy, the in-hospital and one-year MACE rates remained higher in AMI patients compared with non-AMI patients.