Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support

Hoyle L. Whiteside, Supawat Ratanapo, Arun Nagabandi, Deepak Kapoor

Research output: Contribution to journalArticle

Abstract

Introduction: Elective insertion of a percutaneous circulatory assist device (PCAD) in high-risk patients is considered a reasonable adjunct to percutaneous coronary intervention (PCI). There is limited data examining the safety and efficacy of rotational atherectomy (RA) without hemodynamic support in patients with reduced left ventricular ejection fraction (LVEF). Methods: We retrospectively identified 131 consecutive patients undergoing RA without elective PCAD over a three-year period. Patients were categorized into three groups: LVEF ≤30%, LVEF 31–50%, and LVEF >50%. The incidence of procedural hypotension, major adverse cardiac events (MACE), and mortality were recorded. Results: Statistical analysis included 18, 42, and 71 patients with LVEF ≤30%, 31–50%, and >50%, respectively. Bailout hemodynamic support was required in four cases. Analysis revealed a significant trend as bailout hemodynamic support was required in 11.1% vs 2.4% (P = 0.1551) in the ≤30% vs 31–50% and 11.1% vs 1.4% (P = 0.0416) in the ≤30% vs >50% subgroups. Combined subgroup analysis also demonstrated statistical significance 11.1% vs 1.8% (P = 0.0324) in the ≤30% vs >30% subgroups. No-reflow phenomenon was more prevalent in patients with reduced LVEF (LVEF ≤30%: 11.1%, LVEF 31–50%: 2.4%, LVEF >50%: 0%; P = 0.0190). Otherwise, no significant differences in in-hospital MACE, or mortality were observed. Conclusion: RA can be effectively utilized in patients with severely reduced LVEF; however, these patients are at increased risk of prolonged procedural hypotension requiring bailout hemodynamic support. If indicated, prompt implementation of hemodynamic support mitigated any impact of procedural hypotension on in-hospital MACE and mortality.

Original languageEnglish (US)
Pages (from-to)660-665
Number of pages6
JournalCardiovascular Revascularization Medicine
Volume19
Issue number6
DOIs
StatePublished - Sep 1 2018

Fingerprint

Coronary Atherectomy
Left Ventricular Dysfunction
Stroke Volume
Hemodynamics
Hypotension
Mortality
No-Reflow Phenomenon
Equipment and Supplies
Percutaneous Coronary Intervention

Keywords

  • Percutaneous coronary intervention
  • Reduced systolic function
  • Rotational atherectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support. / Whiteside, Hoyle L.; Ratanapo, Supawat; Nagabandi, Arun; Kapoor, Deepak.

In: Cardiovascular Revascularization Medicine, Vol. 19, No. 6, 01.09.2018, p. 660-665.

Research output: Contribution to journalArticle

@article{9dde77f96dfe45e8968230c7bb59bb1a,
title = "Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support",
abstract = "Introduction: Elective insertion of a percutaneous circulatory assist device (PCAD) in high-risk patients is considered a reasonable adjunct to percutaneous coronary intervention (PCI). There is limited data examining the safety and efficacy of rotational atherectomy (RA) without hemodynamic support in patients with reduced left ventricular ejection fraction (LVEF). Methods: We retrospectively identified 131 consecutive patients undergoing RA without elective PCAD over a three-year period. Patients were categorized into three groups: LVEF ≤30{\%}, LVEF 31–50{\%}, and LVEF >50{\%}. The incidence of procedural hypotension, major adverse cardiac events (MACE), and mortality were recorded. Results: Statistical analysis included 18, 42, and 71 patients with LVEF ≤30{\%}, 31–50{\%}, and >50{\%}, respectively. Bailout hemodynamic support was required in four cases. Analysis revealed a significant trend as bailout hemodynamic support was required in 11.1{\%} vs 2.4{\%} (P = 0.1551) in the ≤30{\%} vs 31–50{\%} and 11.1{\%} vs 1.4{\%} (P = 0.0416) in the ≤30{\%} vs >50{\%} subgroups. Combined subgroup analysis also demonstrated statistical significance 11.1{\%} vs 1.8{\%} (P = 0.0324) in the ≤30{\%} vs >30{\%} subgroups. No-reflow phenomenon was more prevalent in patients with reduced LVEF (LVEF ≤30{\%}: 11.1{\%}, LVEF 31–50{\%}: 2.4{\%}, LVEF >50{\%}: 0{\%}; P = 0.0190). Otherwise, no significant differences in in-hospital MACE, or mortality were observed. Conclusion: RA can be effectively utilized in patients with severely reduced LVEF; however, these patients are at increased risk of prolonged procedural hypotension requiring bailout hemodynamic support. If indicated, prompt implementation of hemodynamic support mitigated any impact of procedural hypotension on in-hospital MACE and mortality.",
keywords = "Percutaneous coronary intervention, Reduced systolic function, Rotational atherectomy",
author = "Whiteside, {Hoyle L.} and Supawat Ratanapo and Arun Nagabandi and Deepak Kapoor",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.carrev.2018.02.008",
language = "English (US)",
volume = "19",
pages = "660--665",
journal = "Cardiovascular Revascularization Medicine",
issn = "1553-8389",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Outcomes of rotational atherectomy in patients with severe left ventricular dysfunction without hemodynamic support

AU - Whiteside, Hoyle L.

AU - Ratanapo, Supawat

AU - Nagabandi, Arun

AU - Kapoor, Deepak

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Introduction: Elective insertion of a percutaneous circulatory assist device (PCAD) in high-risk patients is considered a reasonable adjunct to percutaneous coronary intervention (PCI). There is limited data examining the safety and efficacy of rotational atherectomy (RA) without hemodynamic support in patients with reduced left ventricular ejection fraction (LVEF). Methods: We retrospectively identified 131 consecutive patients undergoing RA without elective PCAD over a three-year period. Patients were categorized into three groups: LVEF ≤30%, LVEF 31–50%, and LVEF >50%. The incidence of procedural hypotension, major adverse cardiac events (MACE), and mortality were recorded. Results: Statistical analysis included 18, 42, and 71 patients with LVEF ≤30%, 31–50%, and >50%, respectively. Bailout hemodynamic support was required in four cases. Analysis revealed a significant trend as bailout hemodynamic support was required in 11.1% vs 2.4% (P = 0.1551) in the ≤30% vs 31–50% and 11.1% vs 1.4% (P = 0.0416) in the ≤30% vs >50% subgroups. Combined subgroup analysis also demonstrated statistical significance 11.1% vs 1.8% (P = 0.0324) in the ≤30% vs >30% subgroups. No-reflow phenomenon was more prevalent in patients with reduced LVEF (LVEF ≤30%: 11.1%, LVEF 31–50%: 2.4%, LVEF >50%: 0%; P = 0.0190). Otherwise, no significant differences in in-hospital MACE, or mortality were observed. Conclusion: RA can be effectively utilized in patients with severely reduced LVEF; however, these patients are at increased risk of prolonged procedural hypotension requiring bailout hemodynamic support. If indicated, prompt implementation of hemodynamic support mitigated any impact of procedural hypotension on in-hospital MACE and mortality.

AB - Introduction: Elective insertion of a percutaneous circulatory assist device (PCAD) in high-risk patients is considered a reasonable adjunct to percutaneous coronary intervention (PCI). There is limited data examining the safety and efficacy of rotational atherectomy (RA) without hemodynamic support in patients with reduced left ventricular ejection fraction (LVEF). Methods: We retrospectively identified 131 consecutive patients undergoing RA without elective PCAD over a three-year period. Patients were categorized into three groups: LVEF ≤30%, LVEF 31–50%, and LVEF >50%. The incidence of procedural hypotension, major adverse cardiac events (MACE), and mortality were recorded. Results: Statistical analysis included 18, 42, and 71 patients with LVEF ≤30%, 31–50%, and >50%, respectively. Bailout hemodynamic support was required in four cases. Analysis revealed a significant trend as bailout hemodynamic support was required in 11.1% vs 2.4% (P = 0.1551) in the ≤30% vs 31–50% and 11.1% vs 1.4% (P = 0.0416) in the ≤30% vs >50% subgroups. Combined subgroup analysis also demonstrated statistical significance 11.1% vs 1.8% (P = 0.0324) in the ≤30% vs >30% subgroups. No-reflow phenomenon was more prevalent in patients with reduced LVEF (LVEF ≤30%: 11.1%, LVEF 31–50%: 2.4%, LVEF >50%: 0%; P = 0.0190). Otherwise, no significant differences in in-hospital MACE, or mortality were observed. Conclusion: RA can be effectively utilized in patients with severely reduced LVEF; however, these patients are at increased risk of prolonged procedural hypotension requiring bailout hemodynamic support. If indicated, prompt implementation of hemodynamic support mitigated any impact of procedural hypotension on in-hospital MACE and mortality.

KW - Percutaneous coronary intervention

KW - Reduced systolic function

KW - Rotational atherectomy

UR - http://www.scopus.com/inward/record.url?scp=85042909582&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042909582&partnerID=8YFLogxK

U2 - 10.1016/j.carrev.2018.02.008

DO - 10.1016/j.carrev.2018.02.008

M3 - Article

C2 - 29525558

AN - SCOPUS:85042909582

VL - 19

SP - 660

EP - 665

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

SN - 1553-8389

IS - 6

ER -