Bailout rotational atherectomy in patients with myocardial infarction is not associated with an increased periprocedural complication rate or poorer angiographic outcomes in comparison to elective procedures (from the ORPKI Polish National Registry 2015–2016)

Introduction
Many years of experience and refinement of existing rotational atherectomy (RA) techniques have resulted in improved clinical outcomes and a tendency to broaden the spectrum of RA usage.

Aim
To compare the angiographic effectiveness and periprocedural complications in patients with stable angina (SA) and acute myocardial infarction (AMI) treated using RA.

Material and methods
Data were prospectively collected using the Polish Cardiovascular Intervention Society national registry (ORPKI) on all percutaneous coronary interventions (PCIs) performed in Poland in 2015 and 2016. In total, 975 RA procedures were recorded out of 221,187 PCI procedures.

Results
We compared angiographic effectiveness and periprocedural complications in 530 patients with SA and 245 with AMI in the RA group of patients, and 60,522 patients with SA and 91,985 with AMI in the non-RA group. The overall rate of periprocedural complications did not differ between SA and AMI patients in the RA group (2.3% vs. 2.0%; p = 0.84), while it was lower in AMI patients from the RA group compared to those from the non-RA group (2.0% vs. 3.0%; p = 0.34). The percentage of patients with angiographic success in the RA group was similar to the non-RA group in SA patients (97.3% vs. 97.1%; p = 0.75), whereas in the AMI group it was significantly higher compared to the non-RA group (96.7% vs. 92.6%; p < 0.001).

Conclusions
The angiographic effectiveness of PCI with RA in patients with AMI was not worse than in patients with SA.