Background:
Coronary atherectomy is often required to facilitate stent delivery in patients with surgical disease who are turned down for coronary artery bypass grafting (CABG). No previous studies have evaluated one-year outcomes in patients with surgical disease undergoing multi-vessel atherectomy.
Methods:
We identified 56 patients with no prior history of CABG and at least 1 year follow up, who underwent orbital or rotational atherectomy at a single veteran center from 2016 to 2017. Surgical disease was defined as severe triple-vessel disease or equivalent, or severe left main disease. The primary end point was the rate of 1-year major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause-mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stroke). The secondary endpoint was cardiac death at 1-year.
Results:
Of the 56 patients, 34 (60.7%) had surgical and 22 (39.3%) non-surgical disease. Baseline demographics were similar in both groups; there were no differences in age (71.5±8.4 vs 69.0±4.4, p=0.15), BMI (30.2±5.5 vs 28.9±5.2, p=0.46), race, or gender. There was no difference in choice of atherectomy between groups (p=0.25). Patients with surgical disease were more likely to have heart failure (62.2% vs 13.6%; p<0.001) and peripheral artery disease (35.1% vs 9.1%; p=0.033). The median Syntax 1 score was 28. Angiographic complications were uncommon in both groups (5.8% vs 4.5% dissection, p>0.9; 0% vs 0% perforation, p>0.9; 2.9% vs 0% slow flow/no reflow, p>0.9). Patients with surgical disease were more likely to receive mechanical support (26.47% vs 0%, p=0.008), with 5.8% requiring mechanical support after atherectomy. The primary endpoint was similar in the surgical and non-surgical groups, respectively (20.58% vs 13.63%, p=0.72), as were the individual endpoints of all-cause-mortality (14.71% vs 4.55%, p=0.38), MI (5.88% vs 4.54%, p>0.9), TVR (5.88% vs 9.1%, p=0.6), and stroke (0% vs 0 %, p>0.9). No difference in cardiac death was observed at 1 year (8.82% vs 4.55%, p>0.9).
Conclusions:
Coronary atherectomy facilitates stent delivery in patients with surgical disease and does not portend to poorer outcomes at one year when compared to patients with non-surgical disease.
