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

Background The safety and efficacy of rotational atherectomy (RA) in acute coronary syndrome (ACS) patients treated with different rotational speeds remain unclear.Methods This was an observational retrospective registry. Between February 2017 and January 2022, a total of 283 ACS patients were treated with RA. The patients were divided into two groups: the low-speed group (130,000-150,000rpm,182 cases) and the high-speed group (160,000-220,000rpm,101 cases) according to the maximum RA speed. The primary outcome was the occurrence of hypotension, vasospasm, dissection, slow flow, perforation, bradyarrhythmia, burr entrapment, rotawire fracture during RA, as well as the incidence of heart failure, stent thrombosis, and cardiac death during hospitalization.Results Patients in the low-speed RA group experienced a higher incidence of vasospasm during RA operation (15.4% versus 6.9%, p = 0.040), whereas the incidence of slow blood flow was higher in the high-speed RA group (16.5% versus 27.7%, p = 0.031). There was no significant difference in other complications between the two groups. Moreover, logistic regression analysis identified rotational speed (160,000-220,000rpm) as a predictor of slow flow during RA operation (OR = 1.900, 95%CI:1.006–3.588, p = 0.048). For every 10,000 rpm increase in rotational speed, the risk of slow flow increased by 27% (OR = 1.273, 95% CI: 1.047–1.547, p = 0.015).Conclusion ACS patients treated with a lower RA speed (130,000-150,000 rpm) had a higher risk of vasospasm, while in patients where higher speeds were used (160,000-220,000 rpm ), a higher incidence of slow flow was identified. High rotational speed (160,000-220,000 rpm) is an independent risk factor for slow flow during RA in ACS patients.