Abstract
OBJECTIVE: To evaluate the safety and efficacy of rotational atherectomy (RA) in the treatment of complex coronary calcified lesions and to identify factors associated with patient prognosis. METHODS: A retrospective study was conducted on 200 patients who underwent RA at Hunan Provincial People's Hospital between January 2022 and March 2024. Baseline demographics, angiographic, procedural, and laboratory variables were collected. Major adverse cardiovascular events (MACE) after discharge were recorded through scheduled clinic visits and telephone follow-up (median, 12 months). All patients received standardized RA, intracoronary imaging guidance, and 12-month dual antiplatelet therapy. Pre- and post-procedural parameters were compared using paired tests, and multivariable logistic regression was performed to identify independent predictors of adverse outcomes. RESULTS: RA significantly increased the minimum lumen area (2.31 mm(2) vs. 5.80 mm(2), P<0.001) and minimum lumen diameter (1.61 mm vs. 2.50 mm, P<0.001). Among the 181 patients completing follow-up, 43 (23.8%) developed heart failure, and 19 (10.5%) died. Multivariate analysis identified hypertension (OR=3.201, P=0.005) and diabetes mellitus (DM, OR=1.915, P=0.038) as independent risk factors for poor prognosis. In patients with both hypertension and DM, older age (OR=1.069, P=0.046), left main coronary artery lesion (OR=4.270, P=0.013), and maximum burr diameter (OR=292.231, P=0.006) were strongly associated with adverse outcomes. CONCLUSION: RA effectively improves luminal dimensions in complex coronary calcified lesions. Concomitant hypertension and DM are independent risk factors for poor prognosis after RA. Among patients with both conditions, advanced age, left main coronary artery lesion, and larger maximum burr diameter may predict worse clinical outcomes.