The Incidence of Complication in the Perioperative Period of Rotational Atherectomy in Patients With Acute Coronary Syndrome: A Retrospective Study of Low Speed Versus High Speed

The safety and efficacy of rotational atherectomy (RA) in patients with acute coronary syndrome (ACS) treated with different rotational speeds remain unclear. This was an observational retrospective registry study. Between February 2017 and January 2022, a total of 283 patients with ACS were treated with RA. The patients were divided into 2 groups: the low-speed group (130,000 to 150,000 rotations/min [rpm],182 cases) and the high-speed group (160,000 to 220,000 rpm, 101 cases) according to the maximum RA speed. The outcomes analyzed were procedural complications; incidence of heart failure, stent thrombosis, and cardiac death during hospitalization; and 30-day major cardiovascular and cerebrovascular events. Patients in the low-speed RA group had a higher incidence of vasospasm during RA (15.4% vs 6.9%, p = 0.040), whereas the incidence of slow blood flow was higher in the high-speed RA group (16.5% vs 27.7%, p = 0.031). There was no significant difference in other complications or in 30-day major cardiovascular and cerebrovascular events between the 2 groups. Moreover, logistic regression analysis identified rotational speed (160,000 to 220,000 rpm) as a predictor of slow flow during RA (odds ratio 1.900, 95% confidence interval 1.006 to 3.588, p = 0.048). For every 10,000-rpm increase in rotational speed, the risk of slow flow increased by 27% (odds ratio 1.273, 95% confidence interval 1.047 to 1.547, p = 0.015). In conclusion, patients with ACS treated with a lower RA speed (130,000 to 150,000 rpm) had a higher risk of vasospasm, whereas those treated with higher speeds (160,000 to 220,000 rpm) had a higher incidence of slow flow. High rotational speed (160,000 to 220,000 rpm) is an independent risk factor for slow flow during RA in patients with ACS.