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Rotational atherectomy before stenting safe for patients with calcified CAD
In patients with complex calcified CAD, the use of rotational atherectomy before implantation of a paclitaxel-eluting stent is a safe alternative to standard PCI for clinical outcomes at 2 years, according to new data from the ROTAXUS study.
However, there were no significant differences in clinical endpoints between those who had rotational atherectomy and those who did not, according to the researchers.
In the prospective, randomized, multicenter study, researchers evaluated 240 patients (mean age, 71 years) with complex calcified native coronary lesions and diagnosed ischemia enrolled from August 2006 to March 2010. The cohort was a high-risk PCI population with a history of MI and multivessel disease.
Patients were randomly assigned rotational atherectomy followed by stenting (n = 120) or stenting alone (n = 120). The primary endpoint was MACE, defined as a composite of death, MI and target vessel revascularization, at 2 years.
In the overall population, the primary endpoint occurred in 31.8% of patients; this included 17 deaths, 16 cases of MI and 45 cases of TVR.
MACE occurred in 29.4% of the patients who underwent rotational atherectomy and stenting vs. 34.3% of the stenting-only group (RR = 0.86; 95% CI, 0.58-1.27). At 2 years, 8.3% of the rotational atherectomy group vs. 7.4% of the stenting-only group had died (RR = 1.12; 95% CI, 0.45-2.78). The researchers observed similar rates of MI (rotational atherectomy, 8.3%; stenting only, 6.5%; RR = 1.27; 95% CI, 0.49-3.3), TVR (19.3% vs. 22.2%; RR = 0.87; 95% CI, 0.52-1.46) and target lesion revascularization (13.8% vs. 16.7%; RR = 0.83; 95% CI, 0.44-1.55) between the groups.
The researchers noted that despite the initial high angiographic success of rotational atherectomy before stenting, patients with complex calcified lesions face a high risk for recurrent cardiac events.
“Coronary calcification thus remains a challenge for current interventional therapies, and new therapeutic approaches are needed to further improve patients’ outcome,” the researchers wrote. – by Jennifer Byrne
Disclosure: One researcher reports reports serving as a proctor for Boston Scientific and two researchers report supporting educational activities and receiving lecture fees from Boston Scientific.