Long-term Clinical Outcomes of Coronary Rotational Atherectomy for Specific Indications

Objective: This study compared the long-term outcomes between rotational atherectomy (RA) for specific indications and on-label use of RA for severely calcified coronary lesions. Methods: Data for patients who underwent RA between 2015 and 2020 in a single-center registry were analyzed. The specific indication group included patients with ostial lesions, unprotected left main coronary artery stenosis, chronic total occlusions, stent ablation, angulated lesions, and cardiac dysfunction, whereas patients with none of the above-mentioned characteristics were included in the on-label group. The primary endpoint was compared between groups. Results: A total of 176 patients in the on-label group and 125 patients in the specific indication group were included. Patient clinical characteristics were comparable between groups. The incidence of complications during the procedure was higher in the specific indication group than in the on-label group (20.0% vs. 10.8%, P=0.018). No significant difference was observed in in-hospital MACCE between groups (12.5% vs 9.7%, P=0.392). During 35 (10–57) months of follow-up, MACCE occurred in 46 patients (15.3%). The incidence of MACCE was much higher in the specific indication group than the on-label group (25.6% vs 13.6%, P=0.034). Conclusions: RA for specific indications, compared with on-label use, had a higher incidence of complications during the procedure and poorer long-term clinical outcomes.