Prognostic Value of Angiography-derived Microcirculatory Resistance in Patients undergoing Rotational Atherectomy

BACKGROUND Rotational atherectomy (RA) is predominantly employed in the treatment of severe calcification lesions in patients with coronary atherosclerotic heart disease (CAD). Studies focusing on the assessment of postoperative microvascular dysfunction (CMD) after RA and related prognosis are scarce. AIMS we attempted to investigate the predictive significance of coronary angiography-derived microcirculatory resistance (AMR) in patients with coronary RA. METHODS This retrospective study analyzed the data from 114 patients who were successfully treated between January 2019 and September 2022. Coronary microcirculatory function after RA was assessed using AMR. Patients were categorized into CMD and non-CMD groups depending on a postoperative AMR of ≥2.5 mmHg-s/cm. Patients were followed up for postoperative major adverse cardiovascular events (MACE). RESULTS We analyzed the data from 114 patients, and post-RA, the mean AMR, mean QFR, and the percentage of CMDs were significantly higher compared to those before RA. MACE occurred in 14 (12.3%) patients after a year of follow-up. A higher proportion of patients in the MACE group showed post-RA AMR of ≥2.5 mmHg-s/cm (57.1% vs. 27.0%, P=0.048). Cox regression analysis showed that AMR ≥2.5 mmHg-s/cm (HR=3.86, 95%CI. 1.28-11.63, P=0.016) and renal insufficiency (HR=9.92, 95%CI: 2.06-47.83, P=0.004) were independent predictors of MACE. Logistic regression analyses showed the length of the RA operative area and diabetes mellitus (DM) were related to post-RA CMD. CONCLUSION In patients with CAD treated with RA, AMR ≥2.5 mmHg-s/cm independently predicted post-RA MACE; furthermore, the operative length of RA and the comorbid DM were associated with CMD following RA.