Key result
Rotational atherectomy speeds ≥170,000 rpm were associated with a significantly higher risk of slow flow compared to 150,000 rpm (OR 3.18) in patients with coronary heart disease.
Why the study?
Rotational atherectomy is important for managing severe coronary calcification, but the optimal rotational speed has yet to be defined.
Does rotational speed during rotational atherectomy affect procedural complications and six-month MACCE in patients with coronary heart disease and severe coronary calcification?
Observational (n=372)
No
Does rotational speed during rotational atherectomy affect procedural complications and six-month MACCE in patients with coronary heart disease and severe coronary calcification?
Answers are grounded in this paper and cite their sources.
In patients undergoing rotational atherectomy for severe coronary calcification, higher rotational speeds (≥170,000 rpm) increase the risk of slow flow, while lower speeds (<150,000 rpm) increase the risk of vasospasm, suggesting an optimal intermediate speed may balance procedural risks.
Background: Rotational atherectomy (RA) is an important technique for the management of severe coronary calcification. However, optimal rotational speed is yet to be defined. Methods: A total of 372 coronary heart disease (CHD) patients were retrospectively analyzed between February 2017 and January 2022. The patients were divided into four groups based on the maximum RA speed: group 1 (<150,000 rpm, 76 cases), group 2 (150,000 rpm, 156 cases), group 3 (160,000 rpm, 90 cases) and group 4 (≥170,000 rpm, 50 cases). The outcomes analyzed were procedural complications, six-months major cardiovascular and cerebrovascular events (MACCE) and chronic heart failure. Results: Patients in group 4 had a higher incidence of slow flow during the RA operation (p = 0.025). There was no significant difference in other complications among the four groups, as well as six-month MACCE. After adjusting for confounding factors, increase in rotational speed led to a higher probability of slow flow (p for non-linearity = 0.131; adjusted model) and MACCE (p for non-linearity = 0.183; adjusted model). Logistic regression analysis showed that rotational speed was a predictor of slow flow during RA operation (OR = 1.25, 95% CI: 1.05~1.49, p = 0.01). Moreover, the analysis demonstrated that individuals with lower rotational speed (<150,000 rpm) were at 230% higher risk of vasospasm compared with a higher rotational speed (160,000 rpm) (OR = 3.3, 95% CI: 1.08~10.09, p = 0.036). Conclusions: CHD patients treated with a rotational speed of ≥170,000 rpm had a higher risk of slow flow after RA. Rotational speed is an independent risk factor for slow flow in CHD patients. Moreover, a rotational speed of <150,000 rpm was associated with a higher risk of vasospasm compared with rotational speed of 160,000 rpm. There was no significant difference in six-month outcomes in comparison to elective CHD patients with different rotational speeds, and the probability of MACCE was intensified with increase in rotational speed.
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Wu et al. (2023) conducted an observational in Coronary heart disease with severe coronary calcification (n=372). Rotational atherectomy speed ≥170,000 rpm vs. Rotational atherectomy speed 150,000 rpm was evaluated on Slow flow during rotational atherectomy (OR 3.18, 95% CI 1.52-6.63, p=0.002). Rotational atherectomy speeds ≥170,000 rpm were associated with a significantly higher risk of slow flow compared to 150,000 rpm (OR 3.18) in patients with coronary heart disease.
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