In-hospital outcomes after rotational atherectomy in patients with low ejection fraction

Figures & data

Figure 1. Study flow chart. Two hundred seventy-two consecutive patients with heavily calcified coronary stenosis treated with RA followed by stent implantation at New Tokyo Hospital between January 2010 and March 2014 were retrospectively identified. Two patients with acute myocardial infarction were excluded from this study. Therefore, 270 patients were enrolled in this study. Of these, 33 patients had LVEF ≤35% (low LVEF group), and 237 patients had LVEF >35% (preserved LVEF group). RA: rotational atherectomy; LVEF: left ventricular ejection fraction; AMI: acute myocardial infarction.

Table 1. Baseline clinical characteristics.

Patients	Low LVEF (n = 33)	Preserved LVEF (n= 237)	p value
Age	69.7 ± 7	70.8 ± 8.8	.48
Male gender, n (%)	25 (76)	180 (75.9)	1.00
BMI	22.9 ± 4	23.8 ± 3.6	.24
Previous MI, n (%)	30 (91)	68 (28.7)	<.001
Previous PCI, n (%)	18 (55)	98 (41.4)	.19
Prior CABG, n (%)	3 (9)	18 (7.6)	.73
DM, n (%)	18 (55)	121 (51.3)	.85
Diet, n (%)	2 (6)	19 (8.1)	1.00
Oral drug, n (%)	7 (21)	61 (25.8)	.67
Insulin, n (%)	9 (27)	41 (17.4)	.23
HT, n (%)	29 (88)	209 (88.9)	.77
DL, n (%)	19 (58)	172 (72.9)	.10
Smoking, n (%)	18 (58)	145 (63.9)	.56
Current smoker, n (%)	5 (16)	47 (20.7)	.64
Ex-smoker, n (%)	13 (42)	98 (43.2)	1.00
CKD (eGFR <60), n (%)	30 (90)	130 (54.9)	<.001
Hemodialysis, n (%)	16 (49)	54 (22.8)	.003
eGFR	27.8 ± 26	52.3 ± 31.0	<.001
PAD, n (%)	16 (49)	80 (34.0)	.12
EF	31.3 ± 5	58.4 ± 7.8	<.001
Logistic EuroSCORE	13.8 ± 9	5.5 ± 5.3	<.001
Ticlopidine‎, n (%)	4 (12)	24 (10.1)	.76
Clopidogrel, n (%)	29 (88)	211 (89.0)	.77
Prasugrel, n (%)	0 (0)	1 (0.4)	1.00

Data are presented as percentages and absolute numbers or means ± standard deviation, unless otherwise specified.

MI: Myocardial Infarction; PCI: Percutaneous Coronary Intervention; CABG: Coronary Artery Bypass Grafting; DM: Diabetes Mellitus; HT: Hypertension; DL: Dyslipidemia; CKD: Chronic Kidney Disease; e-GFR: estimated Glomerular Filtration Rate; PAD: Peripheral Arterial Disease; EF: Ejection Fraction.

Table 2. Procedural characteristics.

Procedures: n	Low LVEF (n = 33)	Preserved LVEF (n = 237)	p value
Number of diseased vessel
1VD, n (%)	13 (39)	120 (50.6)	.27
2VD, n (%)	12 (36)	83 (35.0)	1.00
3VD, n (%)	8 (24)	34 (14.3)	.20
Left main disease	10 (30)	63 (26.6)	.68
Treated Lesion
LM, n (%)	10 (30)	63 (26.6)	.68
LAD, n (%)	12 (36)	159 (64.1)	.004
LCX, n (%)	8 (24)	31 (13.1)	.11
RCA, n (%)	13 (39)	54 (22.8)	.05
SYNTAX score	25.5 ± 15	23.2 ± 12.2	.36
IABP, n (%)	5 (15)	5 (2.1)	.003
IVUS, n (%)	14 (42)	142 (59.9)	.06
Bifurcation, n (%)	14 (42)	109 (46.0)	.71
Stent type
Xience	16 (52)	133 (63.6)	.24
Promus	3 (10)	12 (5.7)	.42
Resolute	2 (7)	26 (12.4)	.55
Nobori	1 (3)	17 (8.1)	.48
Cypher	2 (7)	3 (1.4)	.13
TAXUS	4 (13)	5 (2.4)	.02
Endeavor	1 (3)	2 (1.0)	.34
BMS	2 (7)	11 (5.3)	.68
Stent diameter	2.97 ± 1	2.69 ± 0.8	.06
Stent length	51.6 ± 32	47.4 ± 31.4	.47
Max Burr Size, n (%)
φ2.25 mm	1 (0.4)	0 (0.0)	1.00
φ2.0 mm	9 (23)	66 (24.2)	1.00
φ1.75 mm	17 (43)	105 (38.5)	.73
φ1.5 mm	10 (25)	87 (31.9)	.47
φ1.25 mm	4 (10)	14 (5.1)	.26
Post dilation, n (%)	29 (88)	183 (77.2)	.26

Data are presented as percentages and absolute numbers or means ± standard deviation, unless otherwise specified.

1VD: One vessel disease; 2VD: Two vessel disease; 3VD: three vessel; LM: Left Main Trunk; LAD Left Ascending LAD: Left Anterior Descending; LCX: Left Circumflex; IABP: intra-aortic balloon pump, IVUS: intravascular ultrasound; BMS: bare metal stent.

Table 3. Procedural and angiographic data.

Procedures: n	Low LVEF (n = 33)	Preserved LVEF (n= 237)	p value
Angiographic success	33 (100)	235 (99.2)	1.00
Procedural duration (min)	58.1 ± 31	61.0 ± 36.3	.66
Contrast amount (cc)	123.5 ± 53	149.6 ± 58.1	.02
Fluoroscopy time (min)	36.3 ± 35	30.0 ± 26.6	.27
Complications
VF, n (%)	0 (0)	1 (0.4)	1.00
Perforation, n (%)	2 (6)	6 (2.5)	.25
Transient hypotension, n (%)	14 (56)	72 (37.9)	.09
Slow flow, n (%)	6 (18)	6 (2.6)	.001
Burr entrapment, n (%)	0 (0)	4 (1.7)	1.00
Broken wires, n (%)	0 (0)	3 (1.1)	1.00
Unsuccessful passage of the burr, n (%)	0 (0)	2 (0.8)	1.00
Final TIMI3 grade, n (%)	33 (100)	235 (99.2)	1.00
Periprocedural MI, n (%)	1 (2)	10 (3.7)	1.00
Drugs
Nitroprusside, n (%)	21 (64)	139 (58.6)	.71
Nitroprusside (μg)	153.0 ± 206	163.6 ± 246.9	.81
Noradrenalin, n (%)	14 (42)	87 (36.7)	.57
Noradrenalin (μg)	20.0 ± 35	13.8 ± 31.9	.30

VF: Ventricular Fibrillation; TIMI: Thrombolysis in Myocardial Infarction; MI: Myocardial Infarction.

Table 4. In hospital outcomes.

	Low LVEF (n = 33)	Preserved LVEF (n = 237)	p value
MACE, n (%)	1 (3)	3 (1.3)	.41
Death, n (%)	1 (3)	2 (0.8)	.33
Cardiac death, n (%)	1 (3)	2 (0.8)	.33
Non-cardiac death, n (%)	0 (0)	0 (0.0)	1.00
Post-procedure onset MI	1 (3)	2 (0.8)	.33
Emergency CABG	0 (0)	0 (0.0)	1.00
TVR, n (%)	1 (3)	1 (2.4)	.23

MACE: Major Adverse Cardiac Event; MI: Myocardial Infarction; CABG: coronary artery bypass grafting; TVR: target vessel revascularization.

Table 5. Clinical outcomes within 30 days.

	Low LVEF (n = 33)	Preserved LVEF (n = 237)	p value
MACE, n (%)	1 (3)	7 (3.0)	1.00
Death, n (%)	2 (6)	5 (2.1)	.21
Cardiac death, n (%)	1 (3)	3 (1.3)	.41
Non-cardiac death, n (%)	0 (0)	0 (0.0)	1.00
TLR, n (%)	1 (3)	4 (1.7)	.48
TVR, n (%)	1 (3)	4 (1.7)	.48
MI, n (%)	1 (3)	4 (1.7)	.48
Emergency CABG, n (%)	0 (0)	0 (0.0)	1.00
Definite/Probable ST, n (%)	1 (3)	4 (1.7)	.48

MACE: Major Adverse Cardiac Event; TLR: target lesion revascularization; TVR: target vessel revascularization; MI: Myocardial Infarction; CABG: coronary artery bypass grafting; ST: stent thrombosis.