COMPARISON OF PATIENTS WITH EITHER LESS-THAN-70-PERCENT DIAMETER NARROWING OR GREATER-THAN-OR-EQUAL-TO-70-PERCENT NARROWING OF THE RIGHT CORONARY-ARTERY WHEN PERFORMING ROTATIONAL ATHERECTOMY ON GREATER-THAN-OR-EQUAL-TO-1 NARROWING IN THE LEFT CORONARY-ARTERIES

This study compares the complication rates of patients undergoing rota tional atherectomy of the left coronary system who had either minimal or significant narrowing of the right coronary artery (RCA). A series of 1,872 patients from a multicenter registry who were treated for lef t coronary artery disease were divided into <70% diameter stenosis (mi ld) and greater than or equal to 70% stenosis (severe) of the RCA. The patient demographics, lesion characteristics, and frequency of proced ural complications for each group were compared. OF the 1,872 patients undergoing rotational atherectomy of the left coronary system, 86.3% (n = 1,616) had mild RCA disease and 13.7% (n = 256) had severe RCA di sease. Comparing the mild and severe groups, death (0.8% vs 3.1%, p < 0.005), non-Q-wave myocardial infarction (5.1% vs 8.6%, p < 0.04), and bypass surgery (2.7% vs 5.8%, p < 0.02) were increased in the severe group. Within the severe group, 7 of 8 deaths were in the 128 patients with total occlusion of the RCA. Multivariate analysis demonstrated t hat RCA stenosis increases the risk of death by 4.9, bypass surgery by 2.6, and non-Q-wave myocardial infarction by 1.8. Patients treated fo r left coronary disease who have greater than or equal to 70% stenosis of the RCA have increased complications during rotational atherectomy . (C) 1997 by Excerpta Medica, Inc.