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Long-term clinical follow-up of patients treated with the coronary rotablator: a single-center experience

The acute angiographic and long-term clinical outcomes of a consecutive series of patients treated with the coronary rotablator at a single center are described. The patient population was a high-risk population, with significant instances of unstable angina or acute myocardial infarctions (MI) on presentation (75.5%), three-vessel coronary artery disease (27.5%), congestive heart failure (23.8%), and diabetes (39%). The coronary anatomy was also complex, with 79.3% of lesions treated being National Heart Lung and Blood Institute (NHLBI) class B or C. The maximum burr:artery ratio averaged 0.79+/-0.11. The maximum balloon:artery ratio averaged 1.19+/-0.17. Acute procedural success was 90%. The reference vessel diameter was 2.72 mm +/-0.54 mm. The average minimum luminal diameter (MLD) preprocedure was 0.87+/-0.31 mm. The average MLD postprocedure was 2.01+/-0.54 mm. The acute gain averaged 1.14+/-0.51 mm. Urgent coronary artery bypass grafting was required in 1% of patients. Subendocardial infarctions occurred in 8.5% of patients, and abrupt closure postprocedure while in hospital occurred in 1% of patients. Reinterventions or coronary artery bypass grafting (CABG) in hospital occurred in only 3.5% of patients; 96% of patients were available for a long-term clinical follow-up. Repeat coronary interventions for target lesion revascularizations were required in 17.4% of patients, coronary artery bypass grafting for target lesion revascularization was necessary in 9.5% of patients, and the combined target lesion revascularization rate was 25.3% at 1 year. Subsequent Q-wave myocardial infarctions or cardiac death occurred in 5.7% of patients at 1 year. Event-free survival was 75.1% at 6 months and 69.9% at 1 year. The strongest predictor of subsequent target lesion revascularization was lesion length (P=0.034) and not the postprocedure MLD (P=0.41). Most major adverse clinical events occurred within the first 4 months and greater than 90% of all major adverse clinical events occurred within the first 6 months. The coronary rotablator was able to achieve a high degree of clinical success in a high-risk patient population with complex anatomy. Most major adverse clinical events occurred early (<6 months) and were comprised principally of target lesion revascularizations. The overall target lesion revascularization rates and combined major adverse clinical event rates are favorable, given the complex anatomy and the high proportion of diabetics, females, and multivessel disease patients treated in this series.