The Systematic Evaluation On Rotational Atherectomy Versus Non-Rotational Atherectomy For Complex Coronary Lesion

Objective: To compare the effectiveness between rotational atherectomy(RA)and non-rotational atherectomy(non-RA)in the treatment of complex coronary lesion.Methods: Pubmed?Web of science and China national knowledge infrastructure(CNKI)were searched.The literatures comparing RA with non-RA with complex coronary lesion published from the built of the databases to May 2018 were collected.The index words included rotational atherectomy?atherectomy and percutaneous coronary intervention.13 studies on rotational atherectomy were included,involving 242650 patients,of which 3474 were treated with rotational atherectomy,and 239176 were treated by non-rotational atherectomy.Results: Compared to non-RA,RA experienced less major adverse cardiac events(MACE)(OR =1.57,95%CI=1.24~1.98,P=0.0002),all caused death at 90 days(OR =1.64,95%CI=1.20~2.23,P =0.002)and 1 year(OR =1.91,95%CI=1.38~2.64,P<0.0001)and more than 1 year(OR =2.19,95%CI=1.07~4.47,P =0.03)after the operation,myocardial infarction at 90 days(OR =1.74,95%CI=1.22~2.49,P =0.002)and 1 year(OR = 1.54,95%CI=1.08~2.19,P =0.02)and more than 1 year(OR =1.97,95%CI=1.33~2.93,P =0.0007)after the operation.There was no significant difference in the success rate of RA,post-operative restenosis rate,target reconstruction/target vessel revascularization(TLR/TVR)at 90 days and 1 year and more than 1 year after RA,MACE at 1 year after RA.Conclusion : Compared with non-RA,there was no significant difference in the success rate of RA and post-operative restenosis rate,but it could significantly reduce all caused death and myocardial infarction at 90 days,1 year and more than 1 year after RA.The Meta analysis shows that RA is effective in the treatment of complex coronary artery lesions.