Predictors of periprocedural myocardial infarction afterrotational atherectomy

Introduction: Rotational atherectomy (RA) presents superior efficacy over traditional balloon angioplasty in managing calcified plaques, albeit being associated with a perceived heightened aggressiveness and increased risk of periprocedural complications.Aim: To assess the frequency and predictive factors of periprocedural myocardial infarction (MI) following RA.Material and methods: This was a retrospective observational study, encompassing 534 patients.The definition of periprocedural MI was consistent with the 4 th universal definition of MI.Results: Periprocedural MI occurred in 45 (8%) patients.This subset tended to be older (74.6 8.2 vs. 72 9.3%; p = 0.04) with SYNTAX Score (SS) > 33 points (p = 0.01), alongside elevated rates of no/slow flow (p = 0.0003).These patients less often fulfilled the indication for RA, which is a non-dilatable lesion.The incidence of traditional risk factors was similar in both groups.Univariable logistic regression models revealed: male gender (OR = 0.54; p = 0.04), non-dilatable lesion (OR = 0.41; p = 0.01), prior coronary artery bypass grafting (CABG) (OR = 0.07; p = 0.01) as negative and SS > 33 (OR = 2.8; p = 0.02), older age (OR = 1.04; p = 0.04), no/slow flow (OR = 7.85; p = 0.002) as positive predictors.The multivariable model showed that occurrence of no/slow flow (OR = 6.7; p = 0.02), SS > 33 (OR = 2.95; p = 0.02), non-dilatable lesion (OR = 0.42; p = 0.02), and prior CABG (OR = 0.08; p = 0.02) were independent predictors of periprocedural MI.Conclusions: Periprocedural MI after RA was not an uncommon complication, occurring in nearly one-twelfth of patients.Our analysis implicated female gender, older age, and more severe coronary disease in its occurrence.As expected, the presence of no/ slow flow amplified the risk of periprocedural MI, whereas prior CABG and non-dilatable lesions mitigated this risk.