Predictors of Clinical Outcomes in Myocardial Infarction Patients Underwent Coronary Intervention With Rotational Atherectomy: A Single‐Center Retrospective Study in Southern Taiwan

OBJECTIVES: Rotational atherectomy (RA) is an established strategy for modifying heavily calcified coronary arteries, but its value in myocardial infarction (MI) remains uncertain. This study compared the clinical outcomes of RA-assisted percutaneous coronary intervention (PCI) in MI and non-MI patients. MATERIAL AND METHODS: We retrospectively analyzed 152 patients undergoing RA-assisted PCI at a tertiary center (2020-2024). Patients were stratified into MI (n = 52) and non-MI (n = 100) groups. Baseline characteristics, procedural outcomes, and follow-up events were compared. The primary endpoints were all-cause mortality, cardiovascular (CV) death, target lesion revascularization (TLR), and major adverse CV events (MACE). RESULTS: Median follow-up was 494 days. Procedural success rates were similar between groups (98.1% vs. 99.0%). The MI group had a lower left ventricular ejection fraction, poorer renal function, and more often required intra-aortic balloon pump support. Periprocedural complications were similar between groups (15.4% vs. 13.0%). The MI group had higher all-cause mortality (32.7% vs. 16.0%, p = 0.018), early (6-month) TLR (6.5% vs. 0%, p = 0.012), and 6- and 12-month MACE rates (23.9% vs. 9.4%, p = 0.020; 19.2% vs. 2.9%, p = 0.006) than the non-MI group. After 1 year of follow-up, clinical outcomes were similar between groups. Multivariate analysis identified reduced ejection fraction as an independent predictor of mortality (p = 0.041). TLR-free survival was not significantly different in multivariate analysis. CONCLUSIONS: RA-assisted PCI is feasible and safe in MI patients, with similar procedural success and complication rates compared to non-MI patients. Impaired left ventricular function and poor renal function were predictors of 1-year all-cause mortality, but long-term TLR-free survival was not.