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Minerva Cardioangiologica 2020 April;68(2):137-45

DOI: 10.23736/S0026-4725.20.05099-9


language: English

Rotational atherectomy-based percutaneous coronary intervention and the risk of contrast-induced nephropathy

Ozan M. DEMIR 1, 2, Enrico POLETTI 1, Francesca LOMBARDO 1, 3, Alessandra LARICCHIA 1, Alessandro BENEDUCE 3, Davide MACCAGNI 1, Alberto CAPPELLETTI 3, Antonio COLOMBO 1, Barbara BELLINI 1, Marco B. ANCONA 1, Mauro CARLINO 1, Alaide CHIEFFO 1, Matteo MONTORFANO 1, Lorenzo AZZALINI 1

1 Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy; 2 Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK; 3 Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy

BACKGROUND: Rotational atherectomy (RA)-related complications (e.g., no-reflow and perforation) may be associated with increased risk of contrast-induced nephropathy (CIN), causing hypotension, acute heart failure, and periprocedural myocardial infarction. Our aim was to evaluate the incidence of CIN in patients undergoing RA-based vs. non-RA-based percutaneous coronary intervention (PCI).
METHODS: This single-center retrospective registry included all patients who underwent PCI between 2012 and 2016 for whom post-procedural creatinine was determined. Study endpoint was CIN, defined as an increase of serum creatinine ≥0.3 mg/dL or ≥50% from baseline within 72 h post-PCI. Propensity score matching (PSM) was performed to account for selection bias between RA and non-RA patients.
RESULTS: Study population included 2580 patients: 70 (3%) had RA PCI and 2510 (97%) had non-RA PCI. Following PSM, there were 70 patients in RA and 280 patients in non-RA group with good overall adjustment between groups, although RA patients received larger contrast volume (263±126 vs. 224±118 mL, P=0.01) and showed higher Mehran risk score at baseline (11.1±6.6 vs. 8.9±4.8, P=0.01). The incidence of CIN was similar between RA and non-RA patients (15.7% vs. 13.2%, P=0.59). New need for dialysis was required in 0% vs. 0.7% patients, respectively (P=0.48). On multivariate analysis, RA PCI was not independently associated with development of CIN.
CONCLUSIONS: Despite being performed in patients with a higher burden of comorbidities and with larger volumes of contrast, RA PCI is not associated with higher risk of CIN, compared with PCI in non-RA patients.

KEY WORDS: Atherectomy; Percutaneous coronary intervention; Acute kidney injury; Renal insufficiency

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