Clinical outcomes after percutaneous coronary intervention with rotational atherectomy: insights from the RA-BIA cohort

INTRODUCTION: Severe coronary calcification remains one of the major challenges in percutaneous coronary intervention (PCI). Rotational atherectomy (RA) facilitates calcium modification, improving stent delivery and expansion, and may therefore enhance both procedural and long‑term outcomes. OBJECTIVES: We aimed to evaluate the temporal trends, procedural performance, and short- and long‑term clinical outcomes of RA in patients with heavily calcified coronary artery disease treated with PCI over a 15‑year period in a single high‑volume center. PATIENTS AND METHODS: Baseline characteristics, procedural outcomes, in‑hospital complications, and follow‑up were assessed. The primary end point was procedural and clinical success; the secondary end point included major adverse cardiovascular and cerebrovascular events (MACCEs; cardiovascular death, myocardial infarction, target vessel revascularization, stroke) at 24 months. RESULTS: Among 1060 patients (median [interquartile range] age, 74 [66-80] y), diabetes and chronic kidney disease were present in 42% and 31.1%, respectively, and 63.8% had prior PCI. Multivessel disease was diagnosed in 36.4%, and 29.4% had the SYNTAX I value equal to or above 32. Technical and clinical success were 97.6% and 86.2%, respectively. Thirty‑day MACCE rate was 10.9%, while at 24 months the MACCE rate was 38.3% and all‑cause mortality rate was 19.4% (cardiovascular, 14.2%). Estimated glomerular filtration rate below 30 ml/min/1.73 m² (subdistribution hazard ratio [sHR], 1.61; 95% CI, 1.11-2.35; P = 0.01) and each 10‑point increase in the SYNTAX I score (sHR, 1.13; 95% CI, 1.04-1.23; P = 0.005) predicted higher MACCE rate, whereas higher left ventricular ejection fraction was protective (sHR, 0.984 per 5% increase; P