Short-term outcomes of rotational atherectomy in patients with reduced left ventricular ejection fraction: A retrospective review from a tertiary referral centre.

Objective: Rotational atherectomy (RA), a commonly used technique for the percutaneous intervention of calcific coronary lesions, produces micro-debris which cause downstream microvascular obstruction, slow flow, and myocardial stunning leading to adverse outcomes in patients with left ventricular (LV) systolic dysfunction. Hence, the presence of LV dysfunction was considered a relative contraindication for RA. We aimed to assess the safety of RA in patients with LV dysfunction.

Method: This is a retrospective review of all consecutive patients who underwent RA at our tertiary referral centre over a 6-year period (2018-2023). All medical records, procedural details, and in-hospital outcomes were recorded. The primary outcome of the study was in-hospital mortality.

Results: 504 patients who underwent RA during the study duration were divided into two groups: Group 1 (n = 209) with left ventricular ejection fraction (LVEF) ≤35 % (mean 29.14 ± 4.95 %) and group 2 (n = 295) with moderately reduced or preserved LVEF >35 % (mean 47.86 ± 6.68 %). There was no significant difference in the baseline demographic characteristics, risk factors, angiographic profile, stent length, contrast volume, and procedure time between the two groups. The in-hospital mortality was not different between the two groups (2.3 % vs 0.7 % p = 0.63). LVEF was not found to be an independent predictor of mortality in patients undergoing RA.

Conclusion: The in-hospital mortality of patients undergoing PCI with RA was not affected by the presence of LV dysfunction. Additional studies with a longer follow-up duration and a larger sample or a meta-analysis incorporating our study are needed to confirm these results.