Clinical outcomes of rotational atherectomy followed by cutting balloon for calcified coronary lesions

Rotational atherectomy is an effective method for treating severe coronary artery calcification; however, several challenges in its clinical application persist. This study aimed to compare the safety and effectiveness of rotational atherectomy combined with cutting balloon (RACB) versus rotational atherectomy with plain balloon (RAPB) in patients with heavily calcified coronary lesions. This retrospective observational cohort study included 326 patients who underwent rotational atherectomy at Shanghai Sixth People's Hospital from January 2016 to December 2022. Patients were divided into two groups (RACB and RAPB) on the basis of the type of balloon used. The primary outcome was the incidence of major adverse cardiovascular events (MACE) 1 year after percutaneous coronary intervention. Propensity score matching (PSM) was applied to minimize bias, and survival analyses were performed with the Cox proportional hazards model. The procedural complication rates of the patients in the RACB and RAPB groups were comparable. Baseline covariates were balanced between groups after adjustment via PSM. Patients receiving RACB during their procedures had a lower MACE rate during the first postprocedural year in the unadjusted analysis (6.7% vs 16.2%, P < 0.05) and after adjustment with PSM (5.6% vs 16.1%, P < 0.01). The Kaplan-Meier survival curves revealed hazard ratios of 0.44 (95% CI: 0.23-0.82; P < 0.05) for the unadjusted model and 0.36 (95% CI: 0.17-0.76; P < 0.01) for the PSM-adjusted model. Performing RACB before stent implantation was demonstrated to be a safe and effective strategy for managing severely calcified coronary lesions.