Prognostic value of angiography-derived microcirculatory resistance in patients undergoing rotational atherectomy- a multi-center study

Abstract

Background: Rotational atherectomy (RA) is predominantly performed to treat severely calcified lesions in patients with coronary atherosclerotic heart disease (CAD). Studies focusing on the assessment of postoperative coronary microvascular dysfunction (CMD) after RA and related prognosis are scarce.

Aims: We investigated the predictive risks of microvascular dysfunction and postoperative major adverse cardiovascular events (MACE) in patients after RA.

Methods: This retrospective and multicenter study analyzed the data from patients after RA between January 2019 and November 2022. The coronary microcirculatory function after RA was assessed using angiography-derived microcirculatory resistance (AMR). Patients were categorized into CMD and non-CMD groups depending on a postoperative AMR of ≥2.5 mm Hg-s/cm. Patients were followed up for MACE.

Results: We analyzed data from 532 patients; after RA, the mean AMR, mean QFR, and percentage of CMDs were significantly higher as compared prior to RA (p < 0.001). A total of 143 (26.9 %) patients had AMR ≥2.5 after the procedure. MACE occurred in 117 (22.0 %) patients after 18 months of follow-up. The proportion of patients with MACE was higher in the AMR ≥ 2.5 than in the AMR < 2.5 (32.1 % vs. 18.2 %, p < 0.001) group. Cox regression analysis showed that AMR ≥2.5 mm Hg-s/cm (HR = 2.01, 95 % CI: 1.39-2.92, p < 0.001), EF and renal insufficiency were independent predictors of MACE. Logistic regression analyses revealed that the length of the RA operative area and presence of diabetes mellitus (DM) were related to post-RA CMD.

Conclusions: The operative length of RA and DM were associated with CMD after RA; furthermore, post-RA AMR ≥2.5 mm Hg-s/cm independently predicted post-RA MACE.

Keywords: Angiographic microvascular resistance; Coronary microvascular dysfunction; Major adverse cardiovascular events; Multicenter study; Rotational atherectomy.