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Rotational atherectomy complicated by coronary perforation is associated with poor outcomes: analysis of 10,980 cases from the British Cardiovascular Intervention Society database

Protty, Majd B., Hussain, Hussain I., Gallagher, Sean, Al-Raisi, Sara, Aldalati, Omar, Farooq, Vasim, Sharp, Andrew S.P., Anderson, Richard and Kinnaird, Tim 2020. Rotational atherectomy complicated by coronary perforation is associated with poor outcomes: analysis of 10,980 cases from the British Cardiovascular Intervention Society database. Cardiovascular Revascularization Medicine 10.1016/j.carrev.2020.07.040

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Abstract

Background Rotational atherectomy (RA) during PCI is linked to a higher likelihood coronary perforations (CP). However, the evidence base on incidence, predictors and outcomes of this complication in RA-PCI remains limited. Methods Using the British Cardiac Intervention Society database, data were analysed on all RA-PCI procedures in UK 2007–2014. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural and outcome associations. Results During 10,980 RA-PCI procedures, 167 CPs were recorded (1.52%) with a stable annual incidence. Baseline and procedural covariates associated with higher rates of RA perforation were number of stents used, female gender, smoking, and left-main stenosis. CP was significantly associated with shock, DC cardioversion, heart block, transfusion, emergency surgery, periprocedural MI, in-hospital major bleed, acute kidney injury, dissection, side branch loss and in-hospital death. CP was also associated with higher rates of in-hospital MACCE (OR 12.22, 95% CI 7.67–19.47), 30-day mortality (OR 10.02, 95% CI 5.87–17.09) and 12-month mortality (OR 3.90, 95% CI 2.53–6.02). Conclusions CP is more frequent in RA-PCI than all-comer PCI and is associated with a significant burden of morbidity and mortality. There are a limited number of baseline and procedural co-variates associated with CP in RA-PCI, making it difficult to predict.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Medicine
Publisher: Elsevier
ISSN: 1553-8389
Date of Acceptance: 28 July 2020
Last Modified: 17 Sep 2020 01:28
URI: http://orca.cf.ac.uk/id/eprint/134823

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