Predictors of Clinical Outcomes in Myocardial Infarction Patients Underwent Coronary Intervention With Rotational Atherectomy: A Single‐Center Retrospective Study in Southern Taiwan

Objectives Rotational atherectomy (RA) is an established strategy for modifying heavily calcified coronary arteries, but its value in myocardial infarction (MI) remains uncertain. This study compared the clinical outcomes of RA‐assisted percutaneous coronary intervention (PCI) in MI and non‐MI patients. Material and Methods We retrospectively analyzed 152 patients undergoing RA‐assisted PCI at a tertiary center (2020–2024). Patients were stratified into MI ( n = 52) and non‐MI ( n = 100) groups. Baseline characteristics, procedural outcomes, and follow‐up events were compared. The primary endpoints were all‐cause mortality, cardiovascular (CV) death, target lesion revascularization (TLR), and major adverse CV events (MACE). Results Median follow‐up was 494 days. Procedural success rates were similar between groups (98.1% vs. 99.0%). The MI group had a lower left ventricular ejection fraction, poorer renal function, and more often required intra‐aortic balloon pump support. Periprocedural complications were similar between groups (15.4% vs. 13.0%). The MI group had higher all‐cause mortality (32.7% vs. 16.0%, p = 0.018), early (6‐month) TLR (6.5% vs. 0%, p = 0.012), and 6‐ and 12‐month MACE rates (23.9% vs. 9.4%, p = 0.020; 19.2% vs. 2.9%, p = 0.006) than the non‐MI group. After 1 year of follow‐up, clinical outcomes were similar between groups. Multivariate analysis identified reduced ejection fraction as an independent predictor of mortality ( p = 0.041). TLR‐free survival was not significantly different in multivariate analysis. Conclusions RA‐assisted PCI is feasible and safe in MI patients, with similar procedural success and complication rates compared to non‐MI patients. Impaired left ventricular function and poor renal function were predictors of 1‐year all‐cause mortality, but long‐term TLR‐free survival was not.