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ROTational AThErectomy in acute coronary syndrome: early and midterm outcomes from a multicentre registry

1. “Città della Scienza e della Salute”, University of Turin, Turin, Italy; 2. Cardiology Department, Ospedale San Giovanni Bosco, Turin, Italy; 3. San Raffaele Scientific Institute, Milan, Italy and EMO-GVM Centro Cuore Columbus, Milan, Italy; 4. Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy; 5. Division of Cardiology, Istituto Humanitas, Milan, Italy; 6. Interventional Cardiology Unit, A.O. Ordine Mauriziano Umberto I, Turin, Italy; 7. Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan; 8. Department of Cardiology, Azienda Ospedaliera Bolognini Seriate, Bergamo, Italy; 9. Department of Cardiology, University Heart Center, University Hospital Zürich, Zürich, Switzerland; 10. Department of Cardiology, Sussex Cardiac Centre, Brighton, United Kingdom

Aims: The safety and efficacy of rotational atherectomy (RA) in patients presenting with non-ST-elevation myocardial infarction (NSTE-ACS) remain to be defined. The aim of our study was to assess the safety and efficacy of RA in NSTE-ACS patients with reference to both short- and long-term follow-up.

Methods and results: This was an observational retrospective registry which enrolled all consecutive patients undergoing RA, comparing patients with stable angina (SA) and NSTE-ACS. In addition, ACS patients were matched with those not undergoing RA. The primary endpoint was angiographic success. Procedural complications and in-hospital MACE were secondary endpoints along with MACE during follow-up. One thousand three hundred and eight patients were included: 37% (484) with an NSTE-ACS diagnosis and 63% (824) in the SA group. Angiographic success did not differ between the groups (98.8% vs. 99.2%, p=0.57). By univariate analysis procedural complications were more frequent in the NSTE-ACS group (11.3% vs. 8.0%, p=0.04). In-hospital MACE rates were comparable (5.7% vs. 5.8%, p=0.93); by multivariate analysis NSTE-ACS patients showed a non-significant trend towards a higher risk of adverse events (HR 2.39, CI: 0.96-5.96, p=0.061). MACE after a median of 27.9 months was significantly higher in the NSTE-ACS group compared with the SA group (32.4% vs. 24.2%, log-rank p<0.001), results confirmed by multivariate analysis. After propensity score matching, NSTE-ACS patients undergoing RA had similar outcomes to ACS patients who did not undergo RA (16% vs. 13%, log-rank p=0.14).

Conclusions: Rotational atherectomy has similar safety and angiographic outcome in patients with NSTE-ACS or SA. The higher rate of adverse cardiac events at follow-up in NSTE-ACS patients undergoing RA is comparable with a matched population of NSTE-ACS patients not undergoing RA.

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