Clinical outcomes of percutaneous coronary intervention with rotablation in patients with acute or recent myocardial infarction

BACKGROUND: Although rotational atherectomy (RA) has been an accepted and widely used medical procedure for more than 15 years, the clinical outcomes of RA in high-risk populations remain elusive. Therefore, the purpose of this study was to investigate the safety and efficacy of RA for patients with acute or recent myocardial infarction (MI), and report the short- and long-term clinical outcomes in this population. METHODS: We enrolled patients undergoing percutaneous coronary intervention (PCI) and RA at two medical centers in Taiwan between January 2004 and December 2013. Individuals who suffered an acute MI within 30 days before RA were assigned to the MI group; the remaining subjects were assigned to the non-MI group. RESULTS: A total of 154 subjects were enrolled in our study, among them: 47 (30.5%) had an acute MI within 30 days of RA (MI group), and the remaining 107 (69.5%) patients without MI comprised the non-MI group. PCI and RA procedures were performed successfully in 150 patients. The 30-day and 1-year total death, MI, and major adverse cardiac event (MACE included all-cause death, MI, and clinical-driven target lesion revascularization) rates were 6.5%, 12.3%, and 15.6%, and 9.7%, 15.2%, and 30.5%, at the 30-day and 1-year follow-ups, respectively. MI was identified as an independent predictor for both 30-day MACE and total death (MACE, OR: 3.95, P = 0.006; total death, OR: 4.67, P = 0.043), and remained an independent predictor for 1-year total death and MI (total death, HR: 4.47, P = 0.007; MI, HR: 2.62, P = 0.016). CONCLUSION: Our study demonstrated the safety and efficacy of RA in patients with acute or recent MI, and identified MI as an independent predictor of both short- and long-term outcomes.