eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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1/2024
vol. 20
 
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abstract:
Original paper

Predictors of periprocedural myocardial infarction after rotational atherectomy

Michał Błaszkiewicz
1
,
Kamila Florek
1
,
Wojciech Zimoch
2
,
Piotr Kübler
2
,
Wojciech Wańha
3
,
Wojciech Wojakowski
3
,
Paweł Pawlus
3
,
Krzysztof Reczuch
2

  1. Students’ Scientific Group of Invasive Cardiology, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
  2. Department of Cardiology, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
  3. Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
Adv Interv Cardiol 2024; 20, 1 (75): 62–66
DOI: https://doi.org/10.5114/aic.2024.137419
Online publish date: 2024/03/25
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Introduction:
Rotational atherectomy (RA) presents superior efficacy over traditional balloon angioplasty in managing calcified plaques, albeit being associated with a perceived heightened aggressiveness and increased risk of periprocedural complications.

Aim:
To assess the frequency and predictive factors of periprocedural myocardial infarction (MI) following RA.

Material and methods:
This was a retrospective observational study, encompassing 534 patients. The definition of periprocedural MI was consistent with the 4th universal definition of MI.

Results:
Periprocedural MI occurred in 45 (8%) patients. This subset tended to be older (74.6 ±8.2 vs. 72 ±9.3%; p = 0.04) with SYNTAX Score (SS) > 33 points (p = 0.01), alongside elevated rates of no/slow flow (p = 0.0003). These patients less often fulfilled the indication for RA, which is a non-dilatable lesion. The incidence of traditional risk factors was similar in both groups. Univariable logistic regression models revealed: male gender (OR = 0.54; p = 0.04), non-dilatable lesion (OR = 0.41; p = 0.01), prior coronary artery bypass grafting (CABG) (OR = 0.07; p = 0.01) as negative and SS > 33 (OR = 2.8; p = 0.02), older age (OR = 1.04; p = 0.04), no/slow flow (OR = 7.85; p = 0.002) as positive predictors. The multivariable model showed that occurrence of no/slow flow (OR = 6.7; p = 0.02), SS > 33 (OR = 2.95; p = 0.02), non-dilatable lesion (OR = 0.42; p = 0.02), and prior CABG (OR = 0.08; p = 0.02) were independent predictors of periprocedural MI.

Conclusions:
Periprocedural MI after RA was not an uncommon complication, occurring in nearly one-twelfth of patients. Our analysis implicated female gender, older age, and more severe coronary disease in its occurrence. As expected, the presence of no/slow flow amplified the risk of periprocedural MI, whereas prior CABG and non-dilatable lesions mitigated this risk.

keywords:

predictors, rotational atherectomy, percutaneous coronary interventions, myocardial infarction, coronary lesions
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