Clinical and angiographic outcomes of rotational atherectomy for patients with calcified coronary lesions: a meta-analysis of randomized and observational studies

Rotational atherectomy (RA) before stenting is still controversial. We aim to evaluate the long-term clinical and angiographic outcomes of RA for patients with calcified coronary lesions after stent implantation. A systematic literature search of Medline, Embase, Cochrane and Ovid Databases were conducted. The clinical endpoints comprised major adverse cardiovascular events (MACEs), target lesion revascularization (TLR), and myocardial infarction (MI). The angiographic outcomes include acute gain, late lumen loss, and restenosis rate. Five randomized controlled trials (RCTs) and thirteen observational studies comprising 5,340 patients were included. Pooled analysis indicated that RA followed by stent decreased the rate of TLR (odds ratio (OR), 0.69; 95% confidence interval (CI), 0.48-0.99; P = 0.04), restenosis (OR, 0.54; 95% CI, 0.40-0.75; P = 0.0002), and have a better acute gain (weighted mean difference (WMD), 0.28; 95% CI, 0.18-0.37; P<0.00001). However, the risk of MI was significantly higher in the RA followed by stent group than the stent-only group (OR, 1.63; 95% CI, 1.15-2.31; P = 0.006). There were no significant differences in the incidence of MACEs (OR, 0.78; 95% CI, 0.46 to 1.32; P = 0.36) and late lumen loss (WMD, -0.03; 95% CI, -0.14 to 0.09; P = 0.65) between the two groups. This meta-analysis confirmed that RA followed by stent is superior to stent alone in terms of TLR, better acute gain, and restenosis during long-term periods. But a higher MI risk existed in patients treated by RA followed by stent technique.