Complex calcific coronary artery disease presents a significant challenge in interventional cardiology. Rotational atherectomy (RA) is a useful tool in treating these lesions but was associated with high rates of restenosis in the COBRA trial. Drug eluting stent technology has vastly reduced restenosis rates but there is little data on outcome after RA and stent insertion.
A retrospective analysis was performed of patients undergoing RA in our centre between 1999 and 2008. One year follow up was performed by patient questionnaire and interrogation of the NHS strategic tracking system. Patients were divided by those receiving BMS or DES. The primary outcome of our study was 1-year death, MI and TLR. Secondary endpoints were long term outcome. Results were compared to the 6 month outcomes from the COBRA trial.
Two hundred and two patients underwent RA in the time period studied; 19 patients received no stent leaving 183 patients included for analysis. 76 patients received BMS (group A) while 107 patients received DES (group B). Baseline characteristics were similar in both groups (Abstract 129 Figure 1). 30 day mortality and 1-year mortality was similar in both groups (2.6% vs 0.9% p=0.75 and 4% vs 3.5% p=0.99). One year MI appeared greater in group B but was not statistically significant (1.9% vs 5.1% p=0.65). TLR was higher in group A but again did not reach statistical significance (6.6% vs 2.8% p=0.25) (Abstract 129 Figure 2). Combined 1 year MI, TLR and death was 12% vs 10.3% (p=0.74). Long term mortality was significantly higher in group A at follow up of 1077±791 days and 999±548 days respectively (21% vs 7.5% p=0.009 OR 3.3 95% CI 1.34 to 8.55).
Our results demonstrate a significant improvement at 1 year compared to results from the COBRA trial which presented 6 month findings. Combined MI, TLR and death in both group A and B were significantly lower than that of COBRA (12% and 10.3% vs 35.7% both p<0.001) (Abstract 129 Figure 2). This is despite our population including significantly older patients with a greater lesion length (Abstract 129 Figure 1). Our long term mortality data would also suggest that DES confer a survival benefit in patients undergoing RA. We suggest that our results reflect modern RA practice and enable RA plus stenting to return to the forefront of treatment in complex coronary disease.
- coronary artery disease
- rotational atherectomy