Abstract

Introduction: Severe calcified coronary artery disease (CAD) complicates percutaneous coronary intervention (PCI) by limiting stent expansion, leading to suboptimal outcomes. Rotational atherectomy (RA) has been instrumental in treating calcified lesions, enhancing procedural success. Despite its widespread use, the impact of SYNTAX score, left ventricular dysfunction (LVF), and imaging guidance on outcomes of RA-PCI remains understudied, especially in low-income settings. This study aims to assess these factors in patients undergoing RA-PCI in Central India. Materials and Methods: This retrospective, observational study included 63 patients with calcific coronary lesions who underwent RA-PCI from 2018 to 2023. Patients were categorized based on SYNTAX score, LVEF (<40% vs ≥40%), and use of imaging. The primary outcome was major adverse cardiovascular events (MACE), including death, non-fatal myocardial infarction, and stroke. Statistical analyses were conducted using SPSS. Results: The mean age of patients was 66.8 ± 8.9 years, with 74.6% male and 46% diabetic. Most patients had low SYNTAX scores (<22), and LAD was the most commonly treated vessel. IVUS was used in 23.8% of cases and OCT in 15.9%. The overall MACE rate was 15.9%, with cardiovascular mortality at 11.1%. Imaging-guided PCI showed better survival trends but was not statistically significant. Reduced LVEF (<40%) correlated with worse outcomes, though not statistically significant.

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