Rotational Atherectomy in Acute Coronary Syndrome: A Meta-Analysis

Background: The use of rotational atherectomy (RA) in percutaneous coronary intervention (PCI) of acute coronary syndrome (ACS) is considered relatively contraindicated. There have been several observational studies showing RA use in ACS, however, no systemic studies have been undertaken. We sought to evaluate the feasibility and outcomes of RA PCI in ACS by performing a meta-analysis.

Methods: We searched PUBMED, EMBASE, CINAHL, and Cochrane Central Register of Clinical Trials for any studies that evaluated the role of RA PCI in ACS. The outcomes analyzed were all-cause mortality, cardiac mortality, short and long-term major adverse cardiac events (MACE), procedural complications and cardiac perforations.

Results: There was a total of 8 retrospective studies with a total population of 1237 with a median follow up of 23 months. The median age of the included patient was 73. Angiographic success rate was 97.4%. The rate of all-cause mortality and cardiac mortality were 5% (range 1-12%, p < 0.001, I² = 92%) and 2% (range 0-5%, P = 0.03, I² = 58%) respectively. In-hospital MACE and long-term MACE were 7% (range 3-13%, p < 0.001, I² = 87%) and 29% (range 21-37%, p = 0.21, I² = 34%) respectively. The incidence of total procedural complications was noted to be 7% (range 2-14%, p < 0.001, I² = 90%). Rate of perforation was 1% (range 0-1%, p = 0.9, I² = 0%).

Conclusion: Our results show that RA PCI is feasible in ACS with comparable procedural complications and short-term MACE, but with a higher long-term MACE rate compared to RA PCI in routine cases.