Characteristics and outcomes of rotational atherectomy in a tertiary care cardiology facility in Pakistan

Objectives: To retrospectively review the short term outcomes of rotational atherectomy in a high CathPCI Risk and high Syntax Population. Methodology: A total of 51 patients who underwent RA between 1^st June 2017 and 31^st April 2019 were retrospectively reviewed after approval from ethical review committee. Clinical follow up was obtained for procedural success and major adverse cardiovascular events (MACE) at 3 months. Results: Patients who underwent RA were high risk with a mean Syntax score 32.7±5.9 and mean NCDR CathPCI risk score of 51.1±13. The mean age of the patients were 70 years, majority were males (81%), type 2 diabetics (78%) with chronic kidney disease (52.7%), Non-ST elevated myocardial infarction (NSTEMI) (35%) and Syntax Score>32 (64.8%). Out of 37 individuals, procedural success was reported in all subjects except one in the high risk syntax group. At three months, MACE was reported in 4 patients. Out of these four, one was intra-procedural death, three had repeat myocardial infarction. Out of these three, two declined repeat revascularization and were managed medically. One patient died during admission despite repeat revascularization. Almost all MACE reported, occurred in patients with Syntax>32. Conclusion: Despite high risk Syntax and CathPCI scores, RA led to high immediate procedural success for PCI in calcified lesions at our hospital with infrequent MACE.