Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
In-hospital Outcomes of Rotational Atherectomy in ST-elevation Myocardial Infarction – Results from the Multicenter ROTA-STEMI Network
R. Hemetsberger1, N. Mankerious2, G. Muntané-Carol3, J. Temporal4, D. Sulimov5, L. Gaede6, F. Woitek7, E. Fadeuilhe Grau8, M. Scalamogna9, M. Olschewski10, A. Mitsis11, Z. Ruzsa12, G. Toth13, H. Heyer2, R. Tölg14, J. Gómez-Hospital3, A. Mügge15, C. Hengstenberg16, T. Gori17, S. Cassese9, X. Carrillo Suárez8, M. Abdel-Wahab5, T. Johnson4, G. Richardt2, A. Allali14
1Innere Medizin II / Kardiologie, Medizinische Universität Wien, Wien, AT; 2Herz- und Gefäßzentrum, Segeberger Kliniken GmbH, Bad Segeberg; 3Hospital Universitari de Bellvitge, Barcelona, ES; 4Bristol Heart Institute, Bristol, UK; 5Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 6Medizinische Klinik 2, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen; 7Klinik für Innere Medizin, Kardiologie und Intensivmedizin, Herzzentrum Dresden GmbH an der TU Dresden, Dresden; 8Hospital Universitari Germans Trias i Pujol, Barcelona, ES; 9Deutsches Herzzentrum München, München; 10Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; 11Nicosia General Hospital, Nicosia, CY; 12University of Szeged, Szeged, HU; 13Klinische Abteilung für Pädiatrische Kardiologie, LKH-Univ. Klinikum Graz - Universitätsklinik für Innere Medizin, Graz, AT; 14Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg; 15Medizinische Klinik II, Kardiologie, Klinikum der Ruhr-Universität Bochum, Bochum; 16Innere Medizin II, Klinische Abteilung für Kardiologie, Allgemeines Krankenhaus der Stadt Wien - Medizinischer Universitätscampus, Wien, AT; 17Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz;

Background:

Although, rotational atherectomy (RA) in the setting of ST-elevation myocardial infarction (STEMI) is considered relatively contraindicated, in severely calcified culprit lesions RA may be the last option to achieve procedural success. Data on the use of RA during STEMI are scarce. We sought to investigate the safety and feasibility of RA during primary percutaneous coronary intervention for the treatment of STEMI.

Methods:

In this retrospective observational study, cases of RA during STEMI were collected from 12 centers in five countries. The main outcomes were procedural success (defined by final TIMI flow III, residual stenosis <20%, and successful stent implantation) and in-hospital mortality.

Results:

Data from 104 patients was collected. Mean age was 72.8±9.1 years, 29.8% were female, 37.5% had diabetes. 34.6% of patients presented with cardiogenic shock, resuscitation was performed in 17.3%, and 21.2% of patients received a circulatory assist device. Femoral access was chosen in 57.7% of cases. Initial TIMI 0 flow was present in 30.8% of patients. Left main culprit lesion was present in 12.5% of cases. Bailout RA was performed in 76.9% of cases, as in 43.9% balloon was uncrossable and in 52.2% the lesion was undilatable. Mean burr size was 1.42±0.20mm.

Procedural success was 75% in total and did not differ between shock and non-shock patients (77.8% vs 73.5%, p=ns). Final TIMI III flow was 90.4%, in 81.7% residual stenosis was <20%, stents could be implanted in 95.2% of cases. In-hospital death occurred in 18.3% of cases. In patients presenting with cardiogenic shock in-hospital death was 50%, compared to 1.5% in patients without cardiogenic shock (p<0.0001). In-hospital stent thrombosis occurred in one case, perforation in 1.9% and burr entrapment in 2.9% of cases.

Conclusion:

Patients presenting with STEMI, requiring RA, represent a multi-comorbid population with elevated risk. RA was performed as a bailout strategy in a majority of cases and as such RA is feasible with a relatively high procedural success rate. When excluding patients presenting with cardiogenic shock mortality is low.
https://dgk.org/kongress_programme/jt2023/aP1306.html