Rotational Atherectomy of Left Main Coronary Artery. Short- and Long-Term Outcomes

Abstract

Background The efficacy and safety of percutaneous coronary intervention (PCI) with rotational atherectomy (RA) for left main coronary artery lesions (LM) remain unclear. The aim of this study was to compare RA-PCI of LM (RA-LM) versus RA-PCI of other vessels (RA-non-LM) in patients undergoing PCI.

Method All patients undergoing PCI with RA in Sweden, between 2005 and 2016 were included. Outcomes were major adverse cardiac events (MACE, including death, myocardial infarction (MI) or target vessel revascularisation (TVR)), and major in-hospital complications. Patients were followed up to 3 years. Cox regression with multivariable adjustment was used for comparisons.

Results Patients in the RA-LM group (n 184) were older (74 vs 72 years) and more likely to have a previous coronary artery bypass grafting (48 vs 18%) than RA-non-LM patients (n 1292). The success rate was high (97 vs 96%) in both groups. The odds for major in-hospital complications did not significantly differ between the groups (adjusted Odds ratio 1.06, 95% confidence interval (CI) 0.51-2.18). The adjusted risk for MACE (Hazard ratio (HR) 1.18, 95% CI 0.87-1.60), death or MI did not differ between the groups. However, RA-LM was associated with higher risk for TVR (HR 1.68, 95% CI 1.02-2.76). The risk for MACE did not differ between patients undergoing RA of unprotected LM (without previous CABG) versus protected LM.

Conclusion RA-PCI of LM was feasible, with high success rate and was associated with similar risk for in-hospital complications and MACE but higher risk for TVR, compared with RA-PCI of other vessels.

Note:
Funding declaration: This research received an unrestricted institutional grant from Boston Scientific International S.A (grant number B 420 668 402).

Conflict of Interests: D. Venetsanos reports an institutional grant from Boston Scientific for the present manuscript, L. Desta reports has nothing to declare, C. Pagonis has nothing to declare, S. Zwackman has nothing to declare, J. Jurga has nothing to declare, T. Tödt has nothing to declare,, Sebastian Völz reports speaker fees from Boston Scientific, outside the submitted work, Jonas Persson has nothing to declare, E. Omerovic reports institutional research grant from Astra Zeneca and consulting fees from Novartis, MSD, Astra Zeneca and Bayer, outside the submitted work, J. Alfredsson reports grants and lecture fees from AstraZeneca, Lilly, Pfizer, Bayer, Novartis and Boehringer Ingelheim, and serving on advisory board for AstraZeneca, Novartis and MSD, outside the submitted work.

Ethical Approval: The study was approved by the local ethical review board (Dnr 2017/16-31) and was conducted according to the declaration of Helsinki. Patients do not provide written consent but are informed about their participation in the SCAAR registry and the possibility to opt-out.

Keywords: Rotational atherectomy, rotablator, PCI left main, calcified coronary lesions