HIGH-SPEED ROTATIONAL ATHERECTOMY OF HUMAN CORONARY STENOSES - ACUTE AND ONE-YEAR OUTCOMES FROM THE NEW-APPROACHES-TO-CORONARY-INTERVENTION(NACI) REGISTRY

High-speed rotational atherectomy (RA) is a new percutaneous procedure for treatment of coronary stenoses that operates by the unique mechan ism of plaque abrasion. This article reports acute (in-hospital) outco mes and 1-year follow-up in a large cohort of patients treated with th is device by NACI investigators. A total of 525 patients with 670 lesi ons treated with RA form the substrate of this report. Patients tended to be older (mean age 64.8 years) than those in previously reported s eries of percutaneous transluminal coronary angioplasty (PTCA), with m ore extensive disease and more complex lesions. Calcification was pres ent in 54% of lesions, and eccentricity in 41%. Balloon angioplasty po stdilation was performed after RA in 88% of cases. Angiographic and pr ocedural success (angiographic success without death, Q-wave myocardia l infarction [MI] or emergency coronary artery bypass graft [CABG] sur gery) rates were 89% and 88%, respectively, Acute in-hospital events i ncluded 4 deaths (1%) and 1 emergency CABG surgery (0.4%). MI occurred in 6% of patients, consisting predominantly of non-Q-wave MI (5%). Af ter PA, angiographic complications included coronary dissection (12%), abrupt closure (5%), side branch occlusion (3%), and distal embolizat ion (3%). Most of these were resolved after postdilation except for co ronary dissection, which was present in 15% of lesions treated. Mean l ength of stay was 3 days. At 1-year follow-up, 27% of patients require d target lesion revascularization and 30% had experienced death, Q-wav e MI, or target lesion revascularization. Preprocedural characteristic s that independently predicted 1-year death, Q-wave MI, or target lesi on revascularization were male gender, high risk for surgery, target l esions that were proximal to or in bifurcations, eccentric, long, or h ighly stenosed. RA, even when applied to lesions of traditionally unfa vorable morphology, appears to provide reasonable procedural and angio graphic success rates. Restenosis and progression of disease contribut e to subsequent clinical and procedural events. (C) 1997 by Excerpta M edico, Inc.