In-Hospital and 1-Year Outcomes of Octogenarian and Nonagenarian Patients with Severely Calcified Coronary Lesions Treated with Rotational Atherectomy

INTRODUCTION: Severely calcified coronary lesions are a common challenge in older percutaneous coronary intervention (PCI) populations. We aimed to investigate in-hospital and 1-year outcomes of octogenarian and nonagenarian patients with heavily calcified coronary lesions treated with rotational atherectomy (RA). METHODS: Patients who underwent RA at our center were divided into two groups: octogenarians/nonagenarians (age ≥ 80 years) (n = 194) and younger counterparts (age < 80 years) (n = 591). Patients presented with acute coronary syndrome, and those treated with bare-metal stents were excluded. At 1 year, major adverse cardiac events (MACE) were investigated as a composite of cardiac death, spontaneous myocardial infarction (MI), or target lesion revascularization (TLR). RESULTS: In-hospital adverse outcome rates were 10.3% in the octogenarian/nonagenarian group versus 13.5% in the younger group (p = 0.266). Notably, the octogenarian/nonagenarian group had numerically higher in-hospital mortality (2.1% vs. 0.5%, p = 0.067). However, after adjusting for potential confounders, in-hospital mortality did not differ significantly between study arms (adj. HR 3.68; 95% CI 0.69-19.5, p = 0.126). At 1 year, the octogenarian/nonagenarian group was associated with a higher MACE rate (20% vs. 13%, adj. HR 1.78; 95% CI 1.27-2.50, p = 0.001), which was driven mainly by more cardiac deaths (13% vs. 4%, log-rank p < 0.001). Rates of MI (log-rank p = 0.708) and TLR (log-rank p = 0.333) were comparable between both study arms. CONCLUSIONS: RA is feasible in octogenarian and nonagenarian patients, with in-hospital adverse outcomes comparable to those of younger patients. Advanced age remains a strong predictor of 1-year MACE, given its inherently higher mortality. Graphical abstract available for this article.