The usefulness of IVUS and OCT in patients treated with rotational atherectomy

Abstract Background Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve clinical outcomes of percutaneous coronary interventions (PCIs) in selected subsets of patients. Purpose To investigate whether the use of OCT or IVUS during PCI with rotational atherectomy (RA-PCI) will increase odds for successful revascularization defined as thrombolysis in myocardial infarction (TIMI) 3 flow. Methods Data were obtained from the national registry of PCIs (ORPKI) maintained by the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The dataset includes PCIs spanning from January 2014 to December 2021 Results A total of 6,522 RA-PCIs were analyzed, out of which 708 (10.9%) were guided by IVUS and 86 (1.3%) by OCT. The postprocedural TIMI 3 flow was achieved significantly more often in RA-PCIs guided by intravascular imaging (98.7% vs 96.6%, p<0.0001). Multivariable analysis revealed that using of IVUS and OCT was independently associated with an increased chance of achieving postprocedural TIMI 3 flow by 67% (odds ratio (OR), 1.67; 95% confidence interval (CI): 1.40–1.99; p<0.0001) and 66% (OR, 1.66; 95% CI: 1.09–2.54; p=0.02), respectively. Other factors associated with successful revascularization were as follows: previous PCI (OR, 1.72; p<0.0001) and coronary artery bypass grafting (OR, 1.09; p=0.002), hypertension (OR, 1.14; p<0.0001), fractional flow reserve assessment during angiogram (OR, 1.47; p<0.0001), bifurcation PCI (OR, 3.06; p<0.0001), and stent implantation (OR, 19.6, p<0.0001). Conclusions PCIs with rotational atherectomy guided by intravascular imaging modalities (IVUS or OCT) are associated with a higher procedural success rate compared to angio-guided procedures.