Long-Term Outcomes Following Percutaneous Coronary Intervention With Rotational Atherectomy for Severely Calcified Lesions

Background: While severe calcification is associated with unfavorable clinical outcomes, rotational atherectomy (RA) has been used for lesion modification of severely calcified lesions. However, long-term outcomes after percutaneous coronary intervention (PCI) with RA have not yet been fully investigated. Methods and Results: We enrolled 301 patients with 334 lesions, which were treated using PCI with RA. The primary outcome was target vessel failure (TVF) defined as a composite of cardiac death (CD), target vessel myocardial infarction (MI), and target vessel revascularization (TVR). The secondary outcome was a major adverse cardiac event (MACE), defined as a composite of CD, MI, TVR, and definite stent thrombosis (ST). In addition, the predictors of TVF were evaluated using Cox proportional hazards regression analysis. The mean follow-up duration was 36.6±27.0 months. The cumulative incidence rates of TVF were 20.6%, 29.1%, and 32.5% at 2, 4, and 6 years, respectively. The 6-year cumulative incidence of MACE was 32.9%. The independent predictors of TVF were hemodialysis (hazard ratio 3.22 [95% confidential interval 1.91-5.43]) and diabetes (2.10 [1.24-3.57]). Conclusions: The 6-year TVF rate after RA reached over 30%. Hemodialysis and diabetes significantly impacted the long-term outcome. The strategy of PCI with RA should be carefully selected for severely calcified lesions in patients with hemodialysis and diabetes.